Situated above the inside of the nose and at the base of the brain lies the pituitary gland. Majority of the body's hormones are regulated by this gland. A tumor that impacts the functioning of this gland is called a pituitary adenoma and the most common procedure for removing pituitary tumors is transsphenoidal endoscopic surgery, commonly known as endoscopic pituitary tumor surgery.
An endoscope is a narrow, rigid tube that is normally used in endoscopic pituitary surgery, induced through the nose. The tool is equipped with a built-in light, camera, and microscope. When the surgeon inserts additional devices via the scope to remove the tumor, the camera allows them to watch everything going on inside, on a digital screen which provides an enhanced vision of the tumor inside.
Although the surgery is safe, like all surgical procedures it too carries some common risks of reaction to anesthesia, bleeding, and infection.
Listed below are some of the most common complications after pituitary surgery that may increase the number of hospital or icu stay days:
CSF Rhinorrhea: CSF, or cerebrospinal fluid, is the fluid that surrounds the brain, and it may leak from the nose post-surgery. In some cases, another surgery may be needed to repair this leak.
Meningitis: It’s 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 but causes damage to normal parts of the pituitary gland. Damage to areas of the pituitary that secrete hormones may require hormone replacement.
Bleeding: Some people experience severe and persistent bleeding into the brain or from the nose if a large blood vessel is damaged during surgery.
Visual Impairment: The nerves that are responsible for vision are close to the area of the pituitary gland and can be damaged leading to vision-related problems.
Diabetes Insipidus: Typically, it is of a temporary nature, commonly subsiding within a few weeks post surgery.
Hormonal Imbalances: Hormonal imbalances may arise when the pituitary gland, the body's master gland, releases various hormones. Following tumor removal, there could be a deficiency in hormone levels, potentially necessitating hormone replacement therapy.
There may be other risks, depending on the patient’s specific medical condition. Be sure to discuss any concerns with a doctor before the procedure.
An Endoscopic Pituitary Tumor Surgery may take several hours. A neurosurgeon may work with an ear, nose, and throat (ENT) doctor - as the endoscope tool is inserted through the nose - as a precautionary measure.
Procedure
The endoscope is often inserted through the nose by a specialist. An incision beneath the upper lip may be used in some situations to introduce the endoscope.
The surgeon will reach the sphenoid sinus's bony wall at the rear of the nose by moving the endoscope forward.
The scope is inserted via the opening in the sphenoid sinus to reach the sinus's posterior wall.
A little aperture is created in the sinus's rear wall.
Using a computer and magnets, magnetic resonance imaging (MRI) can be utilized to create images of the pituitary region during the procedure to help guide the surgeons.
The sella, which is the bone covering the pituitary gland, is located in the rear wall of the sphenoid sinus. The dura, the robust lining of the skull, is visible after the thin sella bone is removed. The tumor and pituitary gland are visible once the dura is exposed.
The neurosurgeon uses long gripping instruments to remove the tumor in segments through a tiny hole in the sella. For the surgeon to access the tumor, the tumor's center is removed, causing the tumor margins to collapse inward. The surgeon inserts the endoscope into the sella to check for any hidden tumors after removing all visible tumors. Certain cancers grow sideways into the vein collection known as the cavernous sinus. Removing this part of the tumor without damaging the blood vessels and nerves could be challenging. Radiation therapy may be used in the future to treat any residual tumor.
The surgeon gets ready to seal the sella aperture after removing the tumor. If necessary, a little (2 cm) thigh incision is done to extract a tiny bit of fat. The space left by the removal of the tumor is filled up with the fat transplant. The abdominal incision is sealed with sutures.
A bone graft from the septum fills the opening in the sella floor. When a patient has undergone prior surgery or there is not a sufficient piece of the septum, synthetic graft material may be used. The graft is covered using biological glue. In addition to promoting healing, this adhesive stops the brain's cerebrospinal fluid (CSF) from seeping into the sinuses and nasal cavities.
The patient might have to spend 7-10 days in the hospital post-surgery for rest and observation. In case of any complications, the stay might be lengthened further. However, the patient will need to follow post-surgery care like not applying direct pressure on the face for at least 4 weeks.
Here are some more points to include in post-surgery care:
Consume medications on time
Painkillers to manage headaches
Limit activities
Visits in between with surgeons and endocrinologists
Retake the MRI
Visual examination
The patient must inform their doctors of:
Any headache that is not relieved by medicine
Vomiting and nausea
High temperature
Leaking nosebleeds
Nasal discharge that is aqueous
Elevated urination
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