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Endoscopic Pituitary Surgery

Endoscopic pituitary surgery, also called transsphenoidal endoscopic surgery, is the most common surgery used to remove pituitary tumors. The pituitary gland is located at the bottom of your brain and above the inside of your nose. It is responsible for regulating most of your body's hormones, the chemical messengers that travel through your blood.

Endoscopic pituitary surgery is done with an instrument called an endoscope. An endoscope is a thin, rigid tube that has a microscope, light, and camera built into it, and it's usually inserted through the nose. The camera lets your surgeon watch on a television screen while inserting other special instruments through the scope to remove the tumor.

Reasons for endoscopic pituitary surgery

Endoscopic pituitary surgery is done to remove certain types of tumors that start to grow in your pituitary gland:

  • Hormone-secreting tumors. These growths secrete chemical messengers that travel through the blood.

  • Nonhormone-secreting tumors. These growths, also called endocrine inactive pituitary adenomas, are removed by surgery because as they increase in size they may cause headache and visual disturbances.

  • Cancerous tumors. These growths may be treated with a combination of surgery, cancer drugs, and X-ray treatment.

Risks of endoscopic pituitary surgery

Endoscopic pituitary surgery is a safe type of surgery, but all surgical procedures carry some risk for reaction to anesthesia, bleeding, and infection. Risks and complications that may occur with this type of surgery also include:

  • CSF rhinorrhea. CSF, or cerebrospinal fluid, is the fluid that surrounds the brain, and it may leak from the nose after surgery. In some cases, another surgery may be needed to repair this leak.

  • Meningitis. This is a type of infection occurring in the membrane lining the brain and spinal cord that can occur after surgery. It is more common if the CSF leaks.

  • Damage to normal parts of the pituitary gland. Damage to areas of the pituitary that secrete hormones may require hormone replacement after surgery.

  • Diabetes insipidus. Damage to a part of the pituitary gland that helps control urination may lead to frequent urination and thirst.

  • Severe bleeding. Heavy and persistent bleeding into the brain or from the nose may occur if a large blood vessel is damaged during surgery.

  • Visual problems. The nerves that supply vision are close to the area of the pituitary gland can be damaged.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

Before endoscopic pituitary surgery

You may need to see an endocrinology specialist for an evaluation before surgery. Endocrinologists are the medical specialists that deal with glands and hormones. You may also have your vision checked before surgery.

Endoscopic pituitary surgery is usually done under general anesthesia, so you will be asked to stop eating and drinking after midnight on the night before surgery. You may need to stop taking some types of medications that may increase bleeding during surgery. Don't take any over-the-counter medications before surgery without telling your doctor. You may have several blood tests, a heart rhythm test, and a chest X-ray. These will all be checked before surgery and you will need to be examined by the doctor who gives anesthesia.

During endoscopic pituitary surgery

The actual surgery may take a few hours. In many cases, an ear, nose, and throat specialist will work with a neurosurgeon. These steps may take place:

  • The ear, nose, and throat surgeon usually places the endoscope through the nose. In some cases, the endoscope may be inserted through an incision under the upper lip.

  • The endoscope is advanced until the bony wall of the sphenoid sinus is found at the back of the nose.

  • The sphenoid sinus is opened and the scope is passed through to the back wall of the sinus.

  • A small opening is made in the back wall of the sinus.

  • Magnetic resonance imagining (MRI) may be used to make images of the pituitary area using a computer and magnets during the surgery to help guide the surgeons.

  • When the pituitary area is entered, the neurosurgeon removes the pituitary tumor in small pieces.

  • When all parts of the tumor that can be reached have been removed, the endoscope is removed. Some packing may be placed in the nose to complete the operation.

After endoscopic surgery

You may need to stay in the hospital for a day or two. During this time, nurses will help you with any dressings and bathroom needs. You will be able to return to a normal diet as long as you are taking fluids well. You will be encouraged to get out of bed and walk as soon as you are able. Aftercare at home may include:

  • Pain medication to control headaches, the most common complaint after surgery

  • Restricted activities – no lifting or straining until cleared by your surgeons

  • Follow-up visits with your endocrinologist and surgeons

  • Repeat MRI

  • Visual testing

It is important to let your surgeons know about:

  • Any headache that doesn't go away with medication

  • Nausea and vomiting

  • Fever

  • Bleeding from the nose

  • Watery discharge from the nose

  • Increased urination