Endoscopic pituitary surgery is performed by inserting an endoscope through the nose to remove tumors from the pituitary gland and skull base.
How to Prepare for Surgery
Patients should stop taking all non-steroidal anti-inflammatory medicines (Advil, Motril, Nuprin, Aleve, Naprosyn) and blood thinners (Plavix, aspirin, coumadin) one week before surgery. Patients are advised to stop smoking and chewing tobacco one week before and two weeks after surgery as they can cause bleeding problems. Patients should not eat or drink anything past midnight the night before the surgery.
What to Expect During Endoscopic Pituitary Surgery
The patient is given general anesthesia. Once the patient is asleep, their nose is prepped with antibiotic and antiseptic solution. An image-guidance system will be placed on the patient’s head to help the surgeon navigate through the nose using a 3D map created from the patient’s CT or MRI scans.
The ENT surgeon will then insert the endoscope into one nostril and move it to the back of the nasal cavity. The endoscope contains a light and camera at the end. The surgeon is able to view the video from the camera on a monitor as he or she inserts long instruments through the nostril. Part of the nasal septum is removed and bone-biting instruments are used to open the front wall of the sphenoid sinus.
Next, the thin bone of the sella (which is the bone overlying the pituitary gland) is removed and the dura (tough lining of the skull) is exposed. The dura is then opened to expose the tumor and the pituitary gland.
The surgeon then uses long grasping instruments to remove the tumor. Once the tumor is removed, the surgeon inspects the region to look for hidden tumors that may be growing sideways into the cavernous sinus. However, removing these tumors may cause injury to nerves and vessels. For this reason, radiation may be a better option.
Some operating rooms may be equipped with an intraoperative MRI scanner which provides the surgeon with real-time images of the patient’s brain and helps ensure complete tumor removal.
Once the tumor is removed, the surgeon obtains a small piece of fat from the patient’s abdomen and uses it to fill the empty space left by the tumor. The hole in the sella floor is replaced with bone graft from the septum and biologic glue is applied to the graft in the sphenoid sinus.
Soft, flexible splints may be placed in the nose along the septum to prevent swelling, control bleeding and prevent adhesions from forming that may cause chronic nasal congestion.
After the Procedure
After surgery, the patient’s vital signs will be monitored as they awake from anesthesia. As soon as the patient wakes up, they will be encouraged to get out of bed. Patients may experience headache, nausea and nasal congestion and need medication to alleviate these symptoms.
The day after the surgery, the patient may need to see an endocrinologist to make sure the pituitary gland is producing appropriate levels of hormones. The patient will take hormone-replacement medication if hormone levels are unbalanced. An MRI scan of the brain will be obtained the day after the surgery and if all is well, the patient will be released from the hospital in one to two days.