Endoscopic pituitary surgery

The Pituitary gland is a hormonal gland in the center of head and bottom part of brain. Hormones secreted from the pituitary gland and their functions are as follows:

• Adrenocorticotropic hormone. It ensures the secretion of cortison from adrenal gland.
• Somatotropic hormone ensures the growth.
• Prolactin. It ensures milk production.
• Thyroid stimulating hormone. It ensures Thyroid hormone secretion.

15% of brain tumors is pituitary tumors. Most of them are benign. 75% of pituitary tumors secretes excess hormones. As a result, the following pathologies emerge:

• Cushing syndrome
• Acromegaly
• Prolactinoma
• Hypothyroidism.

The hormone secretion function of the gland is disrupted as tumor grows and hormonal deficiency (hypopituitarism) arises. There can be vision disorders as a result of the impact of large tumors on optic nerve.

Symptoms:

• Face expansion, eye swelling
• Hand and foot growth
• Changes on face, growth in jaw, tongue and facial bones
• Head ache
• Changes in weight, Weight gain and loss
• Constipation
• Dryness in hairs or thinning, hair loss, eyebrow thinning
• Changes in skin
• Cold or hot intolerance
• Sexual disorders
• Abnormal discharge or milk production in breasts, menstrual disorder, hair growth in women,
• Gynecomastia, a decrease in sexual desire
• Nausea, vomiting
• Tendency to fall asleep
• Visual disorder, two vision, decrease in vision

Diagnosis:

Diagnosis is specified with MRT. The levels of hormones in blood are measured (cortisol, FSH, LH, IGF-1, prolactin, testosterone, estradiol, TSH, T4) and analyses related to vision are conducted. Endocrinologist and ophthalmologist examination are carried out.

Operating technique:

Endoscopic technique which was conducted for the first time in 1992 is used more as a result of the development of special surgical navigation systems in recent years. Today, more than 5000 endoscopic pituitary surgeries are being conducted per year in America.

This surgery is performed by neurosurgery and Otolaryngologist. Otolaryngologist performs the opening of the road from nasal passages to sphenoid sinus and in the rear wall of sinus to the sella region and then neurosurgeon performs the removal of tissue entering into the pituitary gland. Interventions with binostril are performed by one surgeon entering from one of the nasal passages and other surgeon entering from the other in different phases of the surgery. There is no need for tampon after the surgery, the defect that may arise can be restored with bone and soft tissues during the surgery. When Cerebrospinal fluid (CSF) comes, that region is restored with special techniques. Waist catheter (lumbar drainage) can be placed to reduce pressure and drug treatment can be applied to reduce CSF pressure in such patients.

Advantages of endoscopic method:

The advantage of the endoscopic method in comparison with classical method is the absence of insensibility in the lip area, having fewer complaints such as nasal bleeding, nasal congestion, not using tampon and the length of stay at hospital being less as it is less invasive. At the same time, it is possible to regulate tumor seeing the parts of sella which cannot be seen with microscope by means of angled endoscopes and protect jugular vein on the side of sphenoid sinus and optic nerve following it with endoscope. The duration of hospitalization after the surgery is less.