Transsphenoidal Pituitary Surgery, Sellar/Parasellar Pathology, and Neuroendocrine Derangements — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style transsphenoidal pituitary surgery, sellar/parasellar pathology, and neuroendocrine derangements viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 46-year-old man with acromegaly secondary to a growth hormone-secreting macroadenoma is booked for endoscopic transsphenoidal surgery. He has coarse facial features, severe mandibular hypertrophy, macroglossia, a history of loud snoring with daytime somnolence, and a thyromental distance of 7 cm. Mallampati score is 4. Detail your comprehensive pre-anaesthetic airway evaluation, intubation strategy, and perioperative monitoring plan.
• SCENARIO 2: During an endoscopic endonasal resection of a pituitary macroadenoma in a 38-year-old woman, the surgeon uses a high-speed drill near the lateral cavernous sinus wall. Suddenly, massive, pulsatile arterial haemorrhage fills the nasal cavity and pharynx. Heart rate jumps from 72 to 125 bpm and blood pressure drops to 60/30 mmHg. Outline your immediate emergency resuscitation and haemostatic protocol.
• SCENARIO 3: A 50-year-old male with Cushing's disease undergoes uneventful transsphenoidal hypophysectomy. On postoperative day 1, his urine output increases to 650 mL/hour for three consecutive hours. The urine is clear and dilute (specific gravity 1.002). Serum sodium has climbed from 138 mmol/L to 154 mmol/L. Formulate your diagnostic confirmation and step-by-step fluid and pharmacological management plan.
• SCENARIO 4: A 34-year-old woman with a giant pituitary macroadenoma has an intraoperative lumbar drain inserted. The surgeon requests lumbar injection of normal saline to push the suprasellar portion into the sellar field. Describe the physiological mechanics, risks, and monitoring required during this manoeuvre.