Endoscopic Hypophysectomy
Endoscopic Hypophysectomy is a minimally invasive endoscopic pituitary surgery that is performed through the natural nasal pathway without any incisions to remove pituitary tumors.
Some facts about Endoscopic Hypophysectomy:
- The pituitary gland is situated at the bottom of your brain and above the inside of your nose which is responsible for regulating most of your body's hormones.
- Endoscopic Hypophysectomy is done with an instrument called an endoscope which is a thin, rigid tube that has a microscope, light, and camera built into it.
- Usually it is inserted through the nose.
- Your surgeon can watch on a television screen with the help of this camera and insert other special instruments through the scope to remove the tumor.
- Tumors can be removed from the pituitary gland and skull base in this minimally invasive surgery to reverses vision problems and restore normal hormone balance.
Preparation for Endoscopic Hypophysectomy:
- Endoscopic Hypophysectomy is usually done under general anesthesia.
- You will be asked to stop eating after midnight on the night before surgery.
- Medications containing aspirin or ibuprofen (Advil, Motrin IB, others) must be avoided for two weeks before and after surgery as these medications may increase bleeding.
- Herbal remedies and over-the-counter supplements should also be avoided.
- Stop smoking if you smoke as smoking slows the healing process after surgery and may make you more likely to get an infection.
- Blood tests, a heart rhythm test, and a chest X-ray will be conducted before surgery.
Procedure for Endoscopic Hypophysectomy:
- An ear, nose, and throat specialist will work with a neurosurgeon during the surgery in many cases.
- The endoscope will be placed through the nose by the ear, nose, and throat surgeon. The endoscope may be inserted through an incision under the upper lip in some cases.
- The endoscope will be advanced till the bony wall of the sphenoid sinus is found at the back of the nose.
- The endoscope will be passed through to the back wall of the sinus after opening the sphenoid sinus.
- A small opening will be made in the back wall of the sinus.
- Images of the pituitary area will be taken using a computer and magnets in Magnetic resonance imagining (MRI) during the surgery to help guide the surgeons.
- Sella is the bone overlying the pituitary gland at the back wall of the sphenoid sinus. The tough lining of the skull called the dura will be exposed by removing the thin bone of the sella.
- The tumor and pituitary gland will be exposed by opening the dura.
- The pituitary tumor will be removed in small pieces by the neurosurgeon by with long grasping instruments through a small hole in the sella.
- The center of the tumor is cored out, so that the tumor margins will fall inward and the surgeon can reach it.
- The surgeon advances the endoscope into the sella to look and inspect for hidden tumor after all visible tumor is removed.
- Some tumors grow sideways into the cavernous sinus, which is a collection of veins. It may be difficult to completely remove the tumor from this portion without causing injury to the nerves and vessels.
- The endoscope is removed when all parts of the tumor that can be reached have been removed.
- Radiation treatment will be used later to remove any tumor that can not be removed during surgery.
- A small skin incision of about 2cm will be made in the abdomen to obtain a small piece of fat if needed.
- The empty space left by the tumor removal can be filled by using this fat graft.
- The abdominal incision will be closed with sutures.
- Usually the hole in the sella floor will be replaced by the bone graft from the septum.
- However, synthetic graft material will be used when there is no suitable piece of septum or the patient has had previous surgery.
- Biologic glue will be applied over the graft in the sphenoid sinus which allows healing and prevents leaking of cerebrospinal fluid (CSF) from the brain into the sinus and nasal cavity.
- Bleeding can be controlled and swelling can be prevented by placing soft, flexible splints in the nose along the septum.
- Adhesions from forming can be prevented by the splints that may lead to chronic nasal congestion.
