Pituitary Macroadenoma with Trigeminal Neurovascular Compression Syndrome and Sjogren’s Syndrome

Sample Opinion // TNTS (Trans-Nasal Trans-Sphenoidal) Surgery // Microvascular Decompression Surgery // Pituitary Macroadenoma // Trigeminal Neurovascular Compression Syndrome // Sjögren’s Syndrome // Trigeminal Neuralgia

Diagnosis: 

As per the shared reports, the patient complains of headaches. Imaging findings demonstrate –

1. An enlarged pituitary gland, suggestive of a Pituitary Macroadenoma.
2. Trigeminal Neurovascular Compression Syndrome.
3. The reports also indicate a diagnosis of Sjögren’s syndrome.

A pituitary macroadenoma is a benign, slow-growing tumor on the pituitary gland ≥ 10 mm in size. It causes symptoms through localized pressure (e.g., headaches, vision loss) or hormonal imbalances. 

Trigeminal neurovascular compression syndrome occurs when a blood vessel presses against the trigeminal nerve (Cranial Nerve V) near the brainstem, leading to severe, episodic facial pain known as trigeminal neuralgia. The constant physical contact and arterial pulsation wear down the protective myelin sheath of the nerve, causing it to misfire and send intense pain signals to the brain.

Sjögren’s syndrome is a chronic autoimmune disorder where your immune system mistakenly attacks moisture-producing glands. It primarily causes severe dry eyes and dry mouth (sicca symptoms) but can also lead to widespread fatigue, joint pain, and organ inflammation.

Our Dilemma -?? Usually, the macroadenoma of Pituitary Gland and Trigeminal Neuralgia occurs only if the macroadenoma enters cavernous sinus. But in this case, the reports shared suggest that the tumor has not yet entered the cavernous sinus. Which brings us to 2 possible scenarios –

1. We need to treat these two as two separate issues.
2. To confirm if there is actually a neurovascular compression or if it is a clinical symptom due to the pituitary tumor and the compression may not actually exist. 

We will need to do some investigations to confirm the diagnosis and existence of the two issues as distinct episodes apart from the Sjogren. 

Investigations needed: 

The patient would need to undergo detailed evaluation including DSA, MRI of brain, Optic tests, and comprehensive hormone evaluations, neurological examination, ANA, Rheumatoid factor, blood tests, and other routine examinations.

Possible line of treatment: 

A definitive treatment can only be suggested after doing a physical and investigative examination of the patient. The patient may need –

1. Endoscopic removal of pituitary macroadenoma by TNTS Surgery.
2. Medical Management for Sjogren’s syndrome.
3. If the Trigeminal Neurovascular compression is confirmed, she will also need a Microvascular Decompression Surgery for Trigeminal Neuralgia.

TNTS (Trans-Nasal Trans-Sphenoidal) surgery is a minimally invasive procedure to remove pituitary tumors and skull base lesions. Surgeons access the tumor by passing an endoscope through the nasal passages and sphenoid sinus. This method leaves no external scars, involves less pain, and enables a faster recovery.

Medical management refers to the systematic coordination of healthcare services to improve clinical outcomes and manage costs. It encompasses care coordination, utilization reviews, and disease management for specific conditions.

In a Microvascular Decompression (MVD), a neurosurgeon places a tiny Teflon pad between the nerve and the pulsing vessel. It is the only treatment that targets the structural cause.

Kindly Note: The advised plan is solely based on the reports shared with us. The final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only.

We would recommend the following hospitals having Top Neurosurgeons as below:

1.Artemis Hospital, Gurgaon // Dr. Aditya Gupta  

2.Amrita Hospitals // Dr. Anandh Balasubramaniam 

3.Sarvodaya Healthcare, Faridabad // Dr. Yawar Shoaib Ali  

4.BLK-MAX Super Specialty Hospital // Dr. Anil kumar kansal 

5.Shalby International Hospital // Dr. Harnarayan Singh 

Stay in India: The patient will require 3-5 days for initial evaluations on an OPD basis and will require 4-6 days of hospitalization for surgery. Post-Discharge the patient may require 10-15 days for follow up and recuperation. Total Length Stay in India will be approx. 3-4 weeks.

In case, the second surgery is needed (Microvascular Decompression), it will be done at a gap of 8-10 days. In this case the total stay may go up to 6 weeks. 

Estimated cost:

The estimated cost of evaluations will be approx. USD 900-1200 on OPD basis.

The Estimated Cost of Surgery (Endoscopic Removal) at various hospitals is as below: –

The estimated cost of medical management, will be between $500-$950 depending upon the hospital chosen.

The Estimated Cost of Microvascular Decompression Surgery if needed at various hospitals is as below: –

The estimated cost of medical management, will be between $800-$950 depending upon the hospital chosen.

Kindly Note: The above rates are on approximate basis; actual charges will depend upon the final plan confirmed based on medical evaluation at the hospital.

Inclusions:

1. The cost of all investigations related to the surgery.

2. The cost of the treatment.

3. The doctor’s fee and surgery charges.

4. The stay of the patient and 1 attendant during hospital admission.

5. All meals for the patient and the attendant as per the available menu while in hospital.

6. Medical Consumables and Medicines while in hospital.

7. The fee for dieticians and nursing while in hospital.

8. It also includes complimentary Airport Transfers, Forex Services, and assistance.

9. Radiation therapy if offered will be done as an out patient.

Exclusions:

1. Any consultation other than in discussion.
2. Extended stay
3. Treatment of any illness

On Arrival:

The patient and patient’s attendants will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist them with the reasonably charged accommodation near the hospital. The patient and attendant may arrange 35-50 USD per day for accommodation and food at the Guest House.

Hope I have been able to give you a satisfactory answer to the query. Do kindly ask for any clarifications needed. I will be happy to answer and shall look forward to assisting you.

Regards,

Abhik.