Endoscopic Pituitary Surgery

The pituitary gland is responsible for producing a number of different hormones that are essential for controlling various body functions. The gland is situated several inches behind the top of the nostril. On occasion, the cells of the pituitary can multiply and grow uncontrollably to produce a tumor. The majority of pituitary tumors are benign and do not spread elsewhere in the body; however, they can cause problems with hormone production that can result in functional problems.

How Pituitary Tumors Can Present

Tumors that cause the pituitary to produce too much of the hormone that controls cortisol production can result in Cushing syndrome. The most common symptoms of Cushing syndrome include:

  • A rounded face
  • Weight gain
  • A hump behind the neck
  • Muscle weakness
  • Easy bruising
  • Purple stretch marks
  • Headaches
  • Vision problems
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Pituitary tumors can cause the gland to produce too much growth hormone. In patients under the age of 18, this leads to a condition known as gigantism, which is characterized by:

  • An enlarged head
  • Coarse facial features
  • A rapid increase in growth
  • Enlarged feet and hands
  • Excessive sweating

Excessive growth hormone can cause acromegaly in patients over 18 years of age. The symptoms of acromegaly include:

  • Headaches and vision problems
  • Increased body hair
  • Enlarged and puffy hands and feet
  • Fatigue
  • Swollen eyelids
  • Thickened nails
  • Back and joint pain

Pituitary tumors can also influence the production of prolactin, which is the hormone that stimulates breast tissue growth and milk production. This can result in menstrual irregularities or infertility in women. The most common menstrual changes that may occur include irregular or infrequent cycles or the absence of periods altogether. Men may experience a shrinking of the testicles, erectile dysfunction, decreased libido, and infertility. Both men and women may start to produce milk from the breasts.

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Endoscopic Surgical Treatment for Pituitary Tumors

The endoscopic method of removing pituitary tumors involves inserting a small endoscope through the nose to locate and open the sphenoid sinus, which is anterior to the pituitary. Instruments are inserted through both nostrils to excise and remove the tumor. The surgeon uses a computer to visualize the location of the instruments and the tumor. The procedure typically takes one to two hours to complete.

The endoscopic technique offers a number of benefits over older methods that involved approaching through the nose or a large incision under the lip and using a large retractor to hold the nostril open:

  • There is less post-operative pain and discomfort.
  • It eliminates the likelihood of cosmetic changes to the nose.
  • The endoscopic approach eliminates the need for incisions under the lip or on the nose.
  • Endoscopic surgery is significantly faster than the traditional technique.
  • There is no need to hold the patient’s head in place using pins.
  • It eliminates the need for placing a retractor in the patient’s nose.
  • There is less likelihood of scarring inside the nose that can affect breathing.
  • The endoscope provides the doctor with a clear view of the tumor cavity.
  • There is no need for intra-operative X-rays and radiation.