Endoscopic Pituitary Surgery

Endoscopic Pituitary Surgery is the most common surgery used to remove pituitary tumors.

November 18, 2021

Endoscopic Pituitary Surgery is the most common surgery used to remove pituitary tumors.

Some facts about Endoscopic Pituitary Surgery:

  • Endoscopic Pituitary Surgery is also called as transsphenoidal endoscopic surgery.
  • The pituitary gland is responsible for regulating most of the hormones of your body which are the chemical messengers that travel through your blood.
  • An endoscope is used in Endoscopic Pituitary Surgery which is a thin, rigid tube containing a microscope, light and camera.
  • An endoscope is usually inserted through the nose.
  • Your surgeon can watch on a television screen through the tiny camera at the tip of endoscope while inserting other special instruments through the scope to remove the tumor.
  • The chance of damaging the brain is very low as no part of the brain is touched during the surgery.
  • Side effects are less and there will be no visible scar.
  • It is hard to take out large tumors in this procedure and is also time consuming.
  • The cure rates are high if the size of tumor is small. However, the chances for a cure are lower and the chance of damaging nearby brain tissue, nerves, and blood vessels is higher i the tumor is large or has grown into the nearby structures such as nerves, brain tissue, or the tissues covering the brain.

Necessacity for Endoscopic Pituitary Surgery:

Certain types of tumors that start to grow in your pituitary gland can be removed by Endoscopic Pituitary Surgery. These include:

  • Hormone secreting tumors that are secrete chemical messengers that travel through the blood.
  • Nonhormone-secreting tumors, also called endocrine inactive pituitary adenomas, increases in size and may cause headache and visual disturbances.
  • Cancerous tumors can be treated with a combination of surgery, cancer drugs, and X-ray treatment.

Risk of Endoscopic Pituitary Surgery:

  • The procedure of Endoscopic pituitary surgery is a safe. However, reaction to anesthesia, bleeding, and infection are common for all surgical procedures.
  • CSF rhinorrhea, Meningitis, Damage to normal parts of the pituitary gland, Diabetes insipidus, Severe bleeding and Visual problems are risks and complications that may occur with this type of surgery.
  • A sinus headache and congestion for up to a week or two after surgery can happen in most people who have transsphenoidal surgery.
  • Brain damage, a stroke, or blindness is quite rare but may happen because of damage to large arteries, to nearby brain tissue, or to nerves near the pituitary during surgery.
  • A person can get meningitis, infection and inflammation of the meninges until the temporary pathway between the nasal sinuses and airways and the brain created during transsphenoidal approach heals.
  • Damage to the meninges can also lead to CSF, or cerebrospinal fluid leakage  out of the nose. Cerebrospinal fluid, is the fluid that surrounds the brain.
  • Some people may develop Diabetes insipidus after the surgery. However, it usually improves on its own within a few weeks after surgery.
  • Damage to the rest of the pituitary can result in other symptoms from a lack of pituitary hormones, especially after treating some larger macroadenomas.

Preparation for Endoscopic Pituitary Surgery:

  • An evaluation should be done before surgery by visiting an endocrinology specialist.
  • You may also have to check your vision before surgery.
  • You will be asked to stop eating and drinking after midnight on the night before surgery as the surgery is usually done under general anesthesia.
  • You should stop taking the medications that may increase bleeding during surgery.
  • Any over the counter medications should not be taken before surgery without telling your doctor.
  • Several test are performed by doctors to determine if Endoscopic  pituitary tumor surgery can be performed on a patient and the risk for future concerns and assessments that typically occur over 1 to 3 weeks before brain tumor surgery.
  • Some of these tests include blood tests, an electro echocardiogram (EEG), X-rays, CT scan and MRI scans.
  • Image guidance with MRI or CT scans will be used by the doctor before surgery to learn as much as they can about the tumor.
  • It is important for the doctor to know the size of the tumor and whether it has spread beyond the pituitary gland in order to plan the best surgical approach and predict how likely it is to take out all of the tumor.

Procedure of Endoscopic Pituitary Surgery:

  • It may take a few hours to perform Endoscopic Pituitary Surgery. An ear, nose, and throat specialist will work with a neurosurgeon in most of the 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 inserted until the bony wall of the sphenoid sinus is found at the back of the nose and the scope is passed through to the back wall of the sinus by opening the the sphenoid sinus.
  • A small opening will be made in the back wall of the sinus.
  • Magnetic resonance imagining (MRI) will be used to make images of the pituitary area during the surgery to help guide the surgeons.
  • The neurosurgeon will remove the pituitary tumor in small pieces When the pituitary area is entered.
  • The endoscope will be removed when all parts of the tumor that can be reached have been removed.
  • Some packing will be be placed in the nose to complete the operation.

Recovery after Endoscopic Pituitary Surgery:

  • You may have to stay in the hospital for a day or two after the surgery.
  • You will be asked to help your nurses to keep a track of the amount of fluids you drink and your urine output to evaluate pituitary function.
  • A team of doctors and nurses who are who are specially trained in neurosurgery, endocrinology, and critical care will help the patient recover after surgery.
  • You will need follow-up visit to a neurosurgeon or endocrinologist and have imaging tests performed periodically to keep an observation.
  • Further treatment may be required after the surgery if the pituitary tumor grows or symptoms worsen.
  • Pain medication will be provided to control headaches, the most common complaint after surgery
  • Repeat MRI and visual testing will be conducted.
  • You should inform your surgeons about any headache that doesn't go away with medication, nausea and vomiting, fever, bleeding from the nose, watery discharge from the nose and increased urination after surgery.