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Emirati woman has tumour removed via nostrils, regains vision

The surgery, which lasted for three hours, was performed through minimally-invasive procedure

Z Al-Sayyari, an Emirati woman in her 50s, is finally breathing a sigh of relief after a pituitary tumour causing severe vision loss and pain has been successfully removed through her nose.

A multidisciplinary team of doctors at Abu Dhabi’s Burjeel Medical City (BMC) performed this life-changing minimally-invasive procedure. According to medical experts, endoscopic tumour resection through the nose is considered the most recent advancement in pituitary surgeries.

For several months, Al-Sayyari had been suffering from headaches and visual deterioration. Later, she was diagnosed with a pituitary tumour by a doctor at a hospital in Al Ain.

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“After feeling the pain and vision obstruction, I consulted multiple ophthalmologists in various hospitals. Their consensus was that the issue lay with my eye nerves. One of the doctors arranged a CT scan and it revealed a 4-cm tumour. The doctor recommended immediate surgery. I then decided to do the procedure at Burjeel Medical City in Abu Dhabi,” said 53-year-old Al-Sayyari.

She consulted Dr Mohamed A Elzoghby, consultant neurosurgery at BMC, who noted that the tumour was pressing against the optic nerve, causing compression and resulting in vision disturbances, and how the surgery could improve her vision.

According to Dr Elzoghby, untreated nonfunctioning pituitary tumours can lead to various complications such as headaches, visual problems, hypopituitarism, and in severe cases, spontaneous bleeding leading to pituitary apoplexy – a medical emergency. In addition to visual impairment, Al-Sayyari was also suffering from pituitary hypofunction, a condition characterised by hormonal imbalances caused by an underactive pituitary gland.

“On the other hand, functioning pituitary adenomas (benign tumour) may cause abnormal elevations in hormone levels. This can manifest as elevated levels of Adrenocorticotropic hormone (ACTH), growth hormone, and prolactin, resulting in Cushing’s disease, acromegaly – a hormonal disorder that develops when your pituitary gland produces too much growth hormone – or hyperprolactinemia. In rare instances, functioning adenomas can lead to secondary hyperthyroidism due to excess secretion of thyroid stimulating hormone,” Dr Elzoghby said while explaining the complexities in the case.

He then decided to perform the minimally invasive procedure through the nostril as the endoscopic approach presented several advantages, including improved visualisation, panoramic view, reduced occurrence of nasal side effects, elimination of the need for a nasal speculum, and no postoperative nasal packing.

“Traditional surgical techniques for such a large tumour often involve a craniotomy, a procedure requiring the removal of a bone flap from the skull to access the pituitary gland. However, this approach carries significant risks, including potential damage to brain structures, increased post-operative pain, and an extended recovery period,” Dr Elzoghby said, adding that the use of an endoscope allows for a clearer view and better maneuverability, ensuring a precise and thorough removal of the tumour.

The doctor planned the surgery in collaboration with the neurosurgery team at BMC, under the supervision of Prof Dr Amr El Shawarbi, director of neuroscience at Burjeel Holdings. Dr Vandana Binu, consultant otolaryngologist, BMC, was also part of the team.

The surgery, which lasted for three hours, was slightly complicated as the tumour was firm and not soft enough to be sucked out by suction, necessitating a meticulous dissection by the doctors to ensure its complete removal.

‘I can see clearly’

After the surgery, the patient’s vision improved significantly, as the tumour-induced compression on the optic nerve was relieved. Restoring normal pituitary function is expected to alleviate her hormonal imbalances, enhancing her overall quality of life.

“During my time in intensive care, I experienced some fatigue, but my joy upon waking up from anaesthesia was beyond words. Before the surgery, my vision had been weak and blurred. However, post-operation, I was able to see clearly and with precision. The eye doctor had warned me that the eye nerve had sustained damage and would not fully recover. I am immensely grateful to God for His grace and thankful to Dr Elzoghby,” a joyous Al-Sayyari said and praised the medical team in the intensive care department.

She will continue to undergo serial hormone and visual checks to confirm the cure, as well as serial MRI follow-up at two, six, and 12 months.

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