Pituitary Endoscopic endonasal pituitary tumor removal

Dr. Jho’s pure endoscopic pituitary surgery was developeded more than 17 years ago.
The surgery is performed through one nostril without dilators or post operation packing.
The endoscope allows panoramic view of the sella turcica, the site of the pituitary gland.
The anatomy is easier to define and so the complete tumor removal with preservation of the normal pituitary gland.
The surgery is performed without the need of fluoroscopy and without radiation to the patient and surgical team.
Hospital stay is usually one day.

Anatomy of the pituitary gland

The pituitary gland is located in the sella turcica, bony structure in the skull base.
Usual size of the gland is few millimeters. Through hormonal secretion the gland controls other important glands like the thyroid, ovaries, adrenals and almost every tissue in the body. The posterior part of the pituitary gland is called neurohypophysis, responsible for ADH secretion. Its role is water absorption from the kidneys.
The pituitary function is vital.

Pathology of the pituitary gland

Tumors that involve the pituitary gland can grow from inside the gland (called adenomas) or outside the gland (Rathke’s cleft cyst or craniopharingiomas). Adenomas can be functioning and can cause Cushing’s disease (Obesity, diabetes, hypertension, etc.), acromegaly (tongue, face, hands and feet enlargement) or prolactinomas (reduced libido, disturbed menstrual period and milk secretion in females).
Non functioning adenomas can cause compression of the optic system with visual disorders (bitemporal hemianopsia). Pituitary tumors can cause headaches and pituitary gland disfunction.

Symptoms

Symptoms can vary, depending on type and size of the tumor. In Cushing’s patients it can cause tiredness, mood changes, morbid obesity, hypertension, diabetes and more. In acromegaly tongue, face, hands, feet and heart enlargement, hypertension, colon cancer may occur. Prolactinomas can cause reduced libido, disturbed menstrual period and milk secretion in females.
In tumors that are larger than 10 millimeters can case visual disorders.
Any pituitary tumor can cause hormonal disturbances.

Diagnosis

The diagnosis is usually done by endocrinologist or neurosurgeon. The diagnosis is made after thorough endocrine exams and brain MRI which includes coronal cuts of the pituitary region. In certain Cushing patients inferior petrosal sinus sampling (IPSS) is necessary for the diagnosis.

Indications for surgery

A) Diagnosis of pituitary tumor on the MRI.

B) Cushing’s disease with proved elevated ACTH.
C) Through endocrine studies.
D) In certain cases of prolactinoma, if patient cannot tolerate or don’t respond to medical treatment.
E) Visual fields and visual acuity necessary in tumors larger than 10 millimeters or have sign of optic system compression on MRI.

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* The information above is partial and for general knowledge. Professional literature is recommended for more complete information.