Endoscopic (Transsphenoidal) Pituitary Surgery

The pituitary is a gland at the lower front part of the brain. It produces hormones and controls the hormone system of the body. A tumour growing in this gland causes symptoms in two ways: by pressing on the tissue around it, and by the hormones it releases.

The gland sits close to the optic nerve. Pressure there causes a slowly growing loss of the visual field, and sometimes a fast loss of sight.

Depending on which hormone is released, the hands, the feet and the face can grow, periods can become irregular, milk can appear from the breast, and the patient can become infertile or impotent. Weight gain and weight loss both happen.

Who treats it

Because of these problems and because of where the gland sits, several specialties are involved. The eye problems belong to ophthalmologists, the hormone problems to endocrinologists, and the surgery to neurosurgeons and ear, nose and throat surgeons together.

Why the route runs through the nose

The pituitary gland pushes into the sphenoid sinus, which lies behind the nasal cavity. The surgeon can therefore reach the tumour through the nose instead of through the brain. This aims to cause as little damage as possible to the tissue around it, and recovery is usually quicker.

Working through the nose lets the ENT surgeon and the neurosurgeon operate together, which makes the operation smoother and causes less harm. In the endoscopic approach the structures inside the nose, such as the septal cartilage, are left in place. The surgeon enters directly through the opening where the sinus drains into the nose, so no packing is needed afterwards.

Safety

The structures next to the gland can cause problems during pituitary surgery. To keep that risk as low as possible, the radiological examinations before surgery must be detailed, computer-assisted navigation is used during the operation when needed, and the surgery is done by experienced surgeons.

In short, the endoscopic route helps the surgeon remove the tumour more completely and keeps problems with the nose to a minimum. Removing the tumour can often reverse the visual problems and restore the normal hormone balance.