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New Message on Pituitary Chat
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From: Acro1974
Message 8 in Discussion
I had sent my records and questions to Dr. McCutcheon and he sent me his
answers. Here they are:
Question1. Based on my most recent and pre-surgical MRIs as well as other
factors do you think my residual tumor is located in the left side of pituitary
and the wall of left cavernous sinus only or it may be spread around the whole
gland? What seems more likely? Answer1: the tumor appears to be sitting in
the left side of the gland, where it had originated, and also infiltrated the
cavernous sinus adjacent.
Question 2. Is it possible to obtain dural specimens around pituitary and
examine them during surgical procedure? If there is no dural invasion in places
other than area near the wall of left cavernous sinus then neurosurgeon will
proceed with the surgery with hypophyseal transposition and subsequent
radiosurgery. If there is dural invasion in the areas slightly beyond the area
of the wall of left cavernous sinus then neurosurgeon will proceed with the
surgery as planned whereas target of radiosurgery will be adjusted accordingly.
And if there is dural invasion around the whole gland the surgery will be
cancelled. Answer2: dural specimens can be obtained from the wall of the
sella but it is relatively unsafe to take specimens of the dura forming the
wall of the cavernous sinus.
Question 3. If I have persistent acromegaly despite hypophysial transposition
with radiosurgery, will it be possible to have another radiosurgery in the
future? Will repeat radiosurgery result in much increase in risk to both the
remaining pituitary and the visual apparatus in my case? Answer3: once
radiosurgery is done, it is not advisable to have another session of
radiosurgery targeting the same area. The radiation doses are very high in
radiosurgery and there is too much chance for significant radiation-induced
damage to normal tissue with a second session. Question 4. What would be
likelihood of surgically and/or radiation induced hypopituitarism after
hypophyseal transposition and subsequent radiosurgery?
What would be my chance of IGF-1 normalization? Answer4: since we dont
transpose gland here at MD Anderson, it is not a question I can answer and it
should be directed to Dr. Couldwell. In our hands, with straightforward tumor
removal followed by radiosurgery, the chance of hypopituitarism is 30-40 % over
the ensuing 5 years. I dont think anyone knows, really, what the chance of the
transpositions causing hypopituitarism would be: there are no large series of
this procedure with associated long term results. Chance of normalization of
IGF-1 would be about 70 % in our hands. If you were to come here we would
likely operated first, clean out the area of tumor to the maximum extent (in
the process making targeting the residual more accurate) then about 3-3 month
later, do a radiosurgery to the certain residual that would still be present in
the cavernous sinus. If you need more specifics than that, or you have more
questions, you would have to come for a face-to-face consultation for a proper
discussion. So it seems that I can get better deal from Dr. Couldwell. If
the procedure will not help it will be because my residual tumor is not
susceptible to radiation to begin with or/and residual tumor is located in
places other than left part of the gland and will not be targeted during
radiosurgery. I will go to Utah in July to see Dr. Couldwel again as well as
radiosurgery doctor; and after that I will go to Standford to talk to Dr. Laws.
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