What can I Expect During Pituitary Adenoma Surgery?

H. Colledge

A pituitary adenoma is a type of brain tumor growing in an area known as the pituitary gland. Pituitary tumors are not usually cancerous, but they can cause problems by producing excess hormones or by growing and crushing structures nearby. The most common treatment is pituitary tumor surgery, using a method known as transsphenoidal endoscopic tumor removal. This type of pituitary adenoma surgery involves extracting the tumor using special instruments inserted through the nose, and has the advantage that there is no unsightly scar. The procedure requires an overnight stay in the hospital and, often, following surgery, a headache is experienced which could last for a few days.

A scalpel is a small, sharp knife that is used in surgeries to make incisions.
A scalpel is a small, sharp knife that is used in surgeries to make incisions.

Transsphenoidal surgery using an endoscope, which is a slender instrument that resembles a telescope, is what is known as a minimally invasive technique. Sometimes known as keyhole surgery, these techniques are carried out using cuts which are much smaller than the ones in traditional, open surgery, and they do not disturb nearby body tissues as much. Patients tend to recover more quickly, and experience fewer complications than with conventional methods.

A fiber-optic tube called an endoscope allows the surgeon to complete the surgery without creating a large incision.
A fiber-optic tube called an endoscope allows the surgeon to complete the surgery without creating a large incision.

During endoscopic pituitary adenoma surgery, access to the tumor is created via a small cut made at the rear of the nasal cavity. The skills of both neurosurgeons and ear, nose and throat, or ENT, surgeons may be combined during the procedure. A general anesthetic is used during surgery, so patients are unconscious throughout the operation, which may take around three hours.

An ENT surgeon normally passes the endoscope through a nostril so it reaches the end of the nasal cavity. A camera on the endoscope records video images of the procedure, which the surgeons can watch on a monitor. Specially adapted surgical tools are inserted into the nostril and used to remove layers of bone and tissue, exposing the brain and revealing the pituitary adenoma. As much of the tumor is removed as possible, in pieces, working outward from the center. If it is necessary to leave some of the tumor behind to avoid damaging important structures nearby, the remainder can be treated later using radiation therapy.

The final stage of pituitary adenoma surgery involves taking a small section of fat from beneath the skin of the abdomen and using it to fill up the hole left after removal of the tumor. Bone grafts and glue are used to replace those layers of bone and tissue which were removed to expose the brain, and splints are positioned inside the nose to help reduce swelling and blood loss. Following pituitary adenoma surgery, patients are given pain relief and encouraged to move and walk as soon as possible. It is often possible to leave the hospital after a couple of days but medication for pain is usually required and it is normal to feel tired.

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