Surgery For Pituitary Tumours Through Nose

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Endoscopic Pituitary Surgery in Ludhiana, Punjab

Endoscopic Pituitary Surgery in Ludhiana, Punjab , Endoscopic pituitary surgery is also known as transsphenoidal endoscopic surgery. This surgical approach is best suited for patients to remove pituitary tumors. Our pituitary gland is located below the brain bottom and inside of the nose, on the top. This part of the body helps in regulating the hormones and sends the necessary chemical messengers through the blood flow.

Who is a suitable candidate for Endoscopic pituitary surgery?

The candidate is suitable for the surgery if they have:

  • Pituitary adenoma: Tumor growth begins in the pituitary gland which might be hormone-secreting or not.
  • Rathke’s cleft cyst: It is a type of benign cyst or sac filled with fluid. It is present between the posterior and anterior lobes of the pituitary gland.
  • Craniopharyngioma: The tumor growth starts around the pituitary stalk and it may even go near the 3rd ventricle. The growth is benign.
  • Meningioma: The tumor growth starts around the spinal cord and brain.
  • Chordoma

Important Note
In case of a prolactinoma or a small (<10mm) non-secretory tumor, then surgery is not suggested. In case, medications are suggested to the patients.

Pain Management

What are the reasons to perform endoscopic pituitary surgery?

  • Hormone-secreting tumors
  • Non-Hormone-secreting tumors
  • Cancerous tumors

What happens before the endoscopic pituitary surgery?

At Neuro Citi Hospital, the well-trained & skilled endocrinology expert will assess your condition. He has the understanding to check the glands and hormones. The doctor might check the vision before surgery. Here’s what you need to do before the surgery:

  • Stop drinking and eating after midnight on the night during surgery
  • The doctor will suggest to you the medications which you need to stop taking. If you want to take any then consult the expert.
  • You need to get a chest X-ray, blood test, and heart rhythm test.
  • If you have had any infections in the past, then make sure to tell your doctor.
  • You need to get your skin washed with CHG (Hibiclens) or Dial soap. It reduces the chances of infection and kills the bacteria.

What do you need to do on the day of surgery?

  • Take shower with antibacterial soap
  • Wear loose-fitting clothes
  • Do not drink, eat food, or eat any candy
  • Wear comfortable shoes
  • If the doctor has suggested you take any medication, then take a small sip of water.
  • Remove nail paint, any accessory, makeup, or contact lens.

What happens during endoscopic pituitary surgery?

Step 1: Getting ready for surgery
  • Lie down on the operating table and you will be administered general anesthesia. After that, the nose is filled with antiseptic and antibiotic solution.
  • The Image-guiding system is placed on the head which allows the surgeon to check the entire nose area.
  • Instruments are added in the area to look at the area and take out the tumor.
Step 2: Make an Incision
  • An endoscope is put into the nostril and it goes way beyond the nasal cavity. It is a thin-like tube which has a camera and light attached to it. The entire process can be checked on the video monitor.
  • Bon-biting instruments will open the sphenoid sinus front part. The bone opening is made in the sphenoid sinus and septum so that sella is reached.
Step 3: Opening of Sella
  • At the back of the sphenoid sinus, there is sella, which is a thin wall. The skull has a tough lining named dura, which will be opened by the surgeon to check the pituitary gland.
Step 4: Take out the tumor
  • A small hole is made in the sella to remove the tumor with the instruments. The center part is cored out so that the surgeon can reach the specific area. Initially, the visible tumors are removed and then the endoscope is put into the sells to take out the rest of the tumor.
  • If anything is left behind, then radiation is suggested to the patients.
  • In some cases, MRI scanners can be used during surgery to do the surgery with more precision. With advanced surgery, the need for 2nd surgery gets reduced.
Step 5: Get the fat graft (Optional)
  • Once the sella opening is closed, the doctor will make a 2cm incision in the abdomen area to take out the fat. Through this, the empty space is filled with the tumor removal. Following that sutures will close the incision.
Step 6: Closing the sella opening
  • The hole in the sella floor is replaced with a bone graft. In some cases, synthetic graft might be used if no appropriate piece is present in the septum.
  • Biologic glue is placed over the graft which helps in healing and reduces the chances of leaking fluid from the nasal cavity and sinus.

What happens after endoscopic surgery?

After the surgery, you may need to do a hospital stay of 1 or 2 days, depending on your condition. During your stay, the nurse will help you with dressing, bathroom assistance, or any other thing. You can take your normal diet as early as possible, but make sure that you take all the fluids. The doctor will give you the green signal when you are allowed to walk. Once you go back to your home, you need to do the following things:

  • Take the pain medication as suggested by the doctor
  • You should not put excess stress on the body or do any unwanted activity which leads to strain.
  • Make sure you visit the doctor for follow-up checkups. You need to visit at least 2 to 4 times.
  • Get the MRI, as suggested
  • Get the visual examination
  • Make sure you get up and walk for 5 to 10 minutes, every 3 to 4 hours.
  • Make sure you consult the doctor when you need to drive, walk, or fly.
  • You should not blow your nose. If you want to cough or sneeze, do it with your mouth.
  • Do not smoke or drink as it increases the healing time.
  • You can take shower, but one day after the surgery.

What are the emergencies to call the doctor?

  • Loss of vision or blurry/double vision getting worse with time, loss of peripheral vision.
  • Seizure
  • Fever over 101.5° (Not getting down by Tylenol)
  • Nose bleeding that does not stop.
  • Excessive thirst, even after drinking water.
  • Frequent urination
  • Signs of incision infection.
  • Rash or itching at the incision.
  • Swelling and tenderness in the calf of one leg.
  • Increased drowsiness, vomiting, confusion, nausea, or headache.

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