Laparoscopic pituitary surgery to remove tumors is performed through the nose, as the pituitary gland is located in the lower part of the brain. Laparoscopic pituitary surgery is used as a modern technique to remove benign pituitary tumors. In this article, learn about endoscopic pituitary surgery in Turkey, the steps of the surgical procedure and how prepare for it.
Endoscopic pituitary surgery is a modern technique performed through the nose to remove tumors from the pituitary gland and the base of the skull. It is a minimally invasive surgical procedure in which the doctor can remove the pituitary tumor through the nostrils and using an endoscope equipped with a small camera, light and long tools to remove the pituitary tumor (In the lower part of the brain).
Pituitary tumors can cause hormonal problems and loss of vision (due to pressure on the optic nerve). Removing the tumor treats vision problems and restores a normal hormonal balance.
What is laparoscopic pituitary surgery?
Endoscopic Pituitary Surgery A delicate surgical procedure performed through the nose and sphenoid sinus to remove a tumor in the pituitary gland.
And ear, nose and throat doctors.
Previously in the traditional method, endoscopic surgery required making an incision above the upper lip and removing a large part of the nasal septum so that the doctor could reach the sphenoid sinus.
Today's endoscopic pituitary surgery, a minimally invasive technique, requires making a small incision in the back of the nasal cavity causing a slight disruption of the nasal tissues.
In both methods, bony holes are required to be made in the nasal septum and sphenoid sinus to access the pituitary gland.
Who is the candidate for laparoscopic pituitary gland surgery?
You may be a candidate for laparoscopic pituitary surgery if you have:
- A tumor in the pituitary gland (whether hormonal or not)
- Benign craniopharyngeal tumor
- Ratke pocket tumor
- meningioma: arises from the meninges; It is the membrane surrounding the spinal cord and brain
- Chordoma: A malignant tumor that grows at the base of the skull
In the case of a small non-secreting pituitary tumor less than 10 mm or a prolactin-secreting tumor, surgery may not be required. These types of tumors respond well to medication and require periodic MRI monitoring. Some tumors have a large spread and may require craniotomy for treatment.
Who does laparoscopic pituitary surgery?
Endoscopic resection of pituitary gland tumors is a delicate operation that doctors from different specialties participate in, with the participation of an ear-nose-throat specialist in sinus and endoscopic surgery, a neurologist and a qualified nursing team.
Preparing for laparoscopic pituitary tumor removal
Laparoscopic pituitary gland surgery requires a visit to the clinic of an endocrinologist and a consultant neurosurgeon. You may need to consult an ophthalmologist in case of vision problems. The doctor will explain the procedure, its steps, its benefits and risks.
The doctor takes your medical history in detail (allergies, medications, previous surgeries), some medications should be continued or stopped on the day of surgery.
Depending on the case, the doctor may order some tests before the pituitary gland surgery (blood test, electrocardiogram) a few days before the surgery.
Before laparoscopic pituitary surgery, the following tips must be adhered to:
- It is forbidden to eat or drink.
- To the hospital, wear loose, well-retailed clothes.
- If you have medications to take the morning of surgery, do so with a few sips of water.
- Remove makeup, hairpins, contact lenses, nail polish, earring, etc.
- Stop taking NSAIDs (ibuprofen, naproxen) and blood thinners (Coumadin, aspirin) seven days before laparoscopic pituitary surgery.
- Stop using nicotine and drinking alcohol one week before a pituitary adenectomy and two weeks after laparoscopic pituitary surgery to avoid any bleeding.
What are the steps for removing a pituitary tumor using laparoscopy in Turkey?
There are six steps of laparoscopic pituitary gland surgery:
- Preparation of the patient: It is performed under general anesthesia, the nose is sterilized with antibiotics and antiseptic solutions, a neuronavigation device is placed on the head, which is similar to a GPS, which helps the surgeon to know the location of the tumor through a three-dimensional map drawn by the device.
- Surgical incision: The doctor inserts the endoscope from the nostril to the back of the nasal cavity. A small part of the nasal septum separating the two nostrils is removed. The front wall of the sphenoid sinus is opened.
- Opening the Turkish saddle bone (Sella): Above the back wall of the sphenoid sinus is the Turkish saddle bone. A thin part of the bone is removed to expose the tough lining of the skull called the dura. After opening the dura, the pituitary tumor is exposed.
- Resection of the mass through a small hole in the saddle, resection of the center of the tumor helps the margins to fall inward so that the surgeon can reach it, after removing the visible tumor, the surgeon laparoscopically looks for any hidden tumor in the skull and tries to remove it, it may be difficult to treat the tumor completely, which requires Post-radiotherapy.
- Placing a graft: After the lumpectomy, the surgeon closes the opening in the Turkish saddle. If necessary, the medical team may suggest taking about 2 cm of abdominal skin to obtain a graft of fat to close the space left by the lumpectomy.
- Closing the hole created by the Turkish saddle with a bone graft from the nasal septum, it is possible to use an artificial graft in some cases, and biological glue is used on the sphenoid sinus to prevent the leakage of cerebrospinal fluid from the brain into the sinuses and nose.
This process usually takes 2-3 hours. The doctor may place soft splints in the nose to control bleeding and prevent swelling, and adhesions that may lead to chronic nasal congestion.
The operation to eradicate the pituitary tumor is performed in the hospital in a special department equipped with an MRI machine during surgery. This technique allows to completely remove the glandular tumor and reduces the need for a second operation.
What after laparoscopic pituitary tumor removal surgery?
- After the operation, patients are transferred to the recovery room, and vital signs are monitored upon awakening by the specialized medical team.
- The endocrinologist will monitor the work of the pituitary gland, and ensure that it secretes hormones appropriately.
- An MRI of the brain is done the next day.
- After a day or two, the patient is discharged from the hospital.
- An ear, nose and throat doctor will be scheduled after a week to remove the splints.
- An appointment with a neurologist will be scheduled 2-4 weeks after the endoscopic pituitary gland surgery.
- You may need a long-term follow-up with a consultant endocrinologist, in case there is a need for hormonal replacement medication (thyroid hormones, cortisol, growth hormone, estrogen or testosterone).
With the following home care instructions for two weeks:
- Don't blow your nose, if you have to while sneezing, do so with your mouth open.
- Do not bend below the waist, and avoid raising intra-abdominal pressure while using the toilet.
- Avoid smoking.
- Do not lift any weight more than 5 pounds.
- After laparoscopic pituitary surgery, a yellowish or mucous-stained nasal discharge that regresses within 1-2 weeks can be expected.
- Nasal crusts and nasal congestion are normal for several weeks after pituitary gland surgery that subside with time.
- You may lose your sense of smell temporarily after pituitary surgery.
- The next day after the pituitary gland surgery, you can shower as long as the head is not immersed in water.
- After laparoscopic pituitary surgery, headaches that are treated with acetaminophen are common.
- Take pain relievers when needed.
- Avoid constipation after laparoscopic pituitary surgery. Eat foods rich in fiber and fluids.
- If a hormone-regulating drug is prescribed, take it carefully and do not miss a dose.
- Get up and walk 5-10 minutes every 3-4 hours, gradually increasing it.
When to contact the doctor after laparoscopic pituitary adenoma surgery?
ought to Call the hospital Immediately if the following symptoms appear:
- a metallic taste of fluid from the nose or throat, this may be cerebrospinal fluid, Call your doctor immediately and avoid strenuous activity.
- Vision loss, peripheral vision loss, or blurry vision after endoscopic surgery for pituitary adenomas.
- Nosebleeds that do not stop after laparoscopic pituitary surgery.
- Excessive thirst or frequent urination.
- Fever over 38.5 degrees.
- If you feel nausea, vomiting, severe headache and drowsiness.
- In the event of swelling or redness in the calf of one of the legs.
What are the results of laparoscopic pituitary adenoma surgery in Turkey?
If the pituitary gland tumors secrete hormones (prolactin-secreting tumors or growth hormone), the doctor monitors the levels of pituitary hormones to ensure recovery.
Cushing's patients usually have small tumors (microscopic tumors) that heal postoperatively in 90% of cases.
As for the tumors of the gland secreting growth hormone, they are often larger and more widespread, and the cure rate for laparoscopic surgery is about 60%.
Some gland tumors are not treated surgically because they invade the cavernous sinuses and other important structures inside the skull, radiotherapy is used to treat tumor remnants in the skull.
If the residual glandular tumor after laparoscopic surgery was secreting hormones, it is possible today to control these hormones pharmacologically.
Since it is impossible to predict whether a pituitary tumor is recurrent or not, periodic MRI monitoring is required.
What are the risks of eradication of the pituitary tumor through the endoscope?
No surgery is without risks. Complications of any surgery may include bleeding, infection, and an allergic reaction to the anesthesia.
Complications of laparoscopic pituitary surgery include:
- Loss of vision: Laparoscopic removal of pituitary tumors may cause damage to the optic chiasm. If there are vision problems before surgery, decompression and removal of the tumor may not restore normal visual function.
- Damage to the pituitary gland: 5-10% occurs in the presence of large tumors, and the medical team recommends hormonal replacement for life for some hormones (such as cortisol, thyroid hormone, growth hormone, estrogen, testosterone).
- Diabetes insipidus: occurs due to damage to the posterior lobe of the pituitary, causes frequent urination and intense thirst, usually temporary and regresses within one to three days, can be controlled with medication.
- Cerebrospinal fluid leak: The fluid around the brain may leak from the nose and may require surgery to correct the leak.
- Sinus congestion.
Bimaristan Specialist Medical Center remains your first choice for treatment in Turkey, we direct you to the best experts in all fields, we accompany you step by step towards recovery, free consultations around the clock, Do not hesitate to contact us, Bimaristan Center answers any questions about treatment in Turkey.
You can also read on our website about Robotic surgery In Turkey and its modern uses.