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, theoretical surgery in which the doctor, through the nostrils and using an endoscope equipped with a small camera, light and long tools, can 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 it secretes hormones or not.
- Benign craniopharyngeal tumor
- Ratke pocket tumor
- Meningioma: It arises from the meninges, 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 spread widely, and their treatment may require a craniotomy.
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 and throat specialist specializing in sinus and endoscopic surgery, a neurologist, and a qualified nursing team.
Preparing for laparoscopic pituitary tumor removal
First, endoscopic pituitary 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, benefits and risks.
The doctor takes your detailed medical history, history of allergies, medications, and previous surgeries. Some medications must be continued or stopped on the day of surgery.
Depending on the situation, 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, shave 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, this process usually takes 2-3 hours.
- First prepare the patient: it is performed under general anesthesia, the nose is sterilized with antibiotics and a solution
antiseptic. The neuronavigation device is placed on the head and is similar to the GPS. It helps the surgeon to know the location of the tumor through a 3D 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 excised to expose the tough lining of the skull called the dura. After opening the dura, the pituitary tumor is exposed.
- Lump excision through a small hole in the sella. Excision of the center of the tumor helps the margins drop inward so that the surgeon can access them. After removing the visible tumor, the surgeon laparoscopically looks for any hidden tumor in the skull and attempts to remove it. It can be difficult to completely treat the tumor, which requires subsequent radiotherapy.
- 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.
- 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 Turkish saddle-implanted opening with a bone graft from the nasal septum, it is possible that an artificial graft may be used in some cases. Biological glue is also used on the sphenoid sinus to prevent leakage of cerebrospinal fluid from the brain into the sinuses and nose.
- The doctor may place soft splints in the nose to control bleeding and prevent swelling, and adhesions that may lead to chronic nasal congestion.
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 functioning of the pituitary gland, making sure it is secreting 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 endoscopic pituitary surgery, a yellowish or mucous-stained nasal discharge is expected. Regression in one to two weeks.
- 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 take a 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.
- In case, feeling nauseous or vomiting or 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 or growth hormone-secreting tumors), 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 adenocarcinoma after laparoscopic surgery is hormonal, today it is possible to control these hormones pharmacologically.
Since it is impossible to predict if 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.
- Pituitary damage: 5-10% occurs in the presence of large tumors. The medical team recommends hormonal replacement for life (cortisol, thyroid hormone, growth hormone, estrogen or 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 Specialized Medical Center has become your first choice for treatment in Turkey. We direct you to the best expert specialists in all fields, accompany you step by step towards recovery. Free consultations around the clock.Do not hesitate to contact us, Bimaristan Family Center in Turkey. You can also read on our website about Robotic surgery In Turkey and its modern uses.
Frequently asked questions and answers about laparoscopic pituitary adenoma surgery in Turkey
What is the success rate of the pituitary gland tumor operation?
According to studiesLaparoscopic pituitary tumor surgery is considered one of the safest operations, the incidence of complications does not exceed 0.6%.
What is the cost of pituitary tumor removal in Turkey?
The cost of pituitary surgery using laparoscopic technology ranges from 3000 to 7000 US dollars.
How is a pituitary tumor headache?
A sudden headache accompanied by a rapid deterioration in the field of vision due to pressure on the nerves surrounding the pituitary gland.
Is the pituitary process dangerous?
Laparoscopic pituitary operations are considered a safe surgery and the complication rate does not exceed 0.6% according to for studies.