A sudden bout of severe headache, followed by an inability to open his right eye and rapidly worsening vision, brought 70-year-old Kolkata resident Rabindranath Das to Manipal Hospital Salt Lake, where doctors discovered a large pituitary tumour with internal bleeding, a condition known as pituitary apoplexyThe bleeding had caused the tumour to expand rapidly, putting pressure on the critical nerves responsible for vision and eye movement and turning what initially appeared to be an eye problem into a medical emergencyIn a multidisciplinary intervention, DrArijit Chakraborty, Neurosurgeon, and DrDebayan Tarafdar, Consultant Otorhinolaryngologist Manipal Hospital Salt Lake, successfully removed the tumour through a minimally invasive endoscopic endonasal approach using a four-hand techniqueFollowing the procedure, the patient experienced significant relief from his headache, while his vision began to improve within just two days.
Rabindranath Das presented to the emergency department with a sudden severe headache, drooping of the right eyelid, inability to open the eye, severely diminished vision and cardiac symptomsAn urgent MRI revealed a large pituitary tumour with internal bleeding, confirming pituitary apoplexy, a potentially serious condition in which sudden bleeding causes the tumour to expand and compress critical surrounding structuresHe was admitted under DrArijit Chakraborty and underwent a minimally invasive, scar-free endoscopic endonasal pituitary surgery using a four-hand technique, performed by him and DrDebayan TarafdarThe tumour was accessed through the nasal passage and sphenoid sinus, without any external incision, and was successfully removedThe painless procedure was completed without complications, and the patient recovered within two days of surgeryPost-surgery, he is recovering well, with his headache having subsided and he is gradually getting his vision back.
Speaking about the patient’s recovery, DrArijit Chakraborty expressed, “The most encouraging aspect of this case has been the patient’s response after surgeryHis severe headache settled considerably and, most importantly, his vision has already improved by around 70% within few daysWe are hopeful that he will continue to regain function over the coming weeksHowever, recovery of the nerves affected by the sudden pressure can take time, so continued follow-up will be importantHis progress so far has been very positive.”
Commenting on the multidisciplinary nature of the procedure, DrDebayan Tarafdar stated, “In complex skull-base procedures, close coordination between the neurosurgical and endoscopic teams is extremely importantThe four-hand technique allows both specialists to work together and use their respective expertise during the procedureIn this case, the patient’s improvement after surgery, particularly the early return of vision, has been very reassuringWhile we expect further recovery, it is important to remember that the nerves involved had been under significant pressure and may need time to recover fully.”
Recalling the experience, Rabindranath Das shared, “The sudden headache and the problem with my right eye were very frighteningI could not open the eye properly, and when I did, my vision was fully blurredI was worried about what would happen to my eyesightBefore the surgery, I was naturally anxious, but the doctors explained the situation very calmly and gave me confidenceAfter the operation, the headache became much better, and I could see a clear improvement in my visionI understand that I still need time to recover fully, but the improvement so far has given me a lot of relief.”
The successful management of this case highlights the importance of early recognition, prompt imaging, timely intervention and multidisciplinary collaboration in patients presenting with pituitary apoplexyThe coordinated efforts of neurosurgery and endoscopic skull-base surgery, supported by a minimally invasive approach, enabled the team to safely address the tumour and relieve the pressure on critical neurological structures, contributing to the patient’s encouraging early recovery.
