----------------------------------------------------------- New Message on Pituitary Chat
----------------------------------------------------------- From: Acro1974 Message 1 in Discussion I had 2 surgeries for acromegaly in 2005. I saw Dr. Couldwell last week. He told me that my residual tumor is located probably in the wall of left cavernous sinus and on the left side of pituitary gland. Dr. Couldwell told that he can remove the portion of the tumor that is located on the gland itself, but not in the wall of the left cavernous sinus. He offered approach of Hypophysial transposition (hypophysopexy) that he developed several years ago. Here is the link: http://www.aans.org/education/journal/neurosurgical/may03/14-5-11.pdf In short, Hypophysial transposition includes removing tumor from pituitary gland, then moving pituitary away from the wall of left cavernous sinus and sticking piece of fat between left cavernous sinus and pituitary gland in order to prevent latter from going back. After 2 weeks Linac radiosurgery will be aimed at the tumor in the area of the wall of left cavernous sinus. Being away from the center of radiation (Dr. Couldwell said it will be 5 mm away), healthy pituitary tissue will not receive as big radiation dosage as during regular radiosurgery; thus the chance of hypopituitarism should be lower. Dr. Couldwell told that he will remove around 10 per cent of healthy pituitary tissue alongside with tumor. Dr. Couldwell also told that chance of surgically induced hypopituitarism is low. He mentioned that he performed around 20 of those procedures (and more than 1000 pituitary surgeries total) and did not observe complications yet. Dr. Couldwell also told that my tumor is somewhat aggressive (5 nuclei positive on pathology report) and that tumor looks somewhat bigger on MRI at 01/07 compared to the MRI at 06/06. So he thinks that tumor should be treated aggressively or I should stop my current Pegvisomant and start Sandostatin LAR instead to suppress the tumor. As far as I understand residual tumor is hardly seen on MRI and some people (like Dr. Jho who operated on me last time) can not see it. If this procedure is so good why other pituitary neurosurgeons dont do it? Another concern is that after piece of fat dissolves, pituitary gland will return to where it was and may contact the wall of left cavernous sinus. Radiation does not inactivate/kill tumor right away so tumor may spread to healthy pituitary again. My endocrinologist does not think it would happen. My endocrinologist wants to start me on HcG injections to increase my testosterone (current level is 323, normal range 220-1000, I am 32 years old male); meanwhile he says to wait because after surgery my testosterone level may increase, stay the same or go lower. Anyway, it seems that even without surgery and radiation I need to be on replacement of one hormone already. Any ideas or suggestions? Here is the link to the article about repeated pituitary surgery: http://64.233.167.104/search?q=cache:IKNDd_RaMM8J:www.thejns-net.org/jns/issues/v102n6/pdf/n1021004.pdf+Repeated+transsphenoidal+surgery&hl=en&ct=clnk&cd=3&gl=us ----------------------------------------------------------- To stop getting this e-mail, or change how often it arrives, go to your E-mail Settings. http://groups.msn.com/PituitaryChat/_emailsettings.msnw Need help? If you've forgotten your password, please go to Passport Member Services. http://groups.msn.com/_passportredir.msnw?ppmprop=help For other questions or feedback, go to our Contact Us page. http://groups.msn.com/contact If you do not want to receive future e-mail from this MSN group, or if you received this message by mistake, please click the "Remove" link below. On the pre-addressed e-mail message that opens, simply click "Send". Your e-mail address will be deleted from this group's mailing list. mailto:[EMAIL PROTECTED]
