PERFORMING MINIMALLY INVASIVE ENDOSCOPIC SURGERY FOR REMOVING PITUITARY GLAND TUMORS
Dr. Ghassan J. Samara, in collaboration with Stony Brook neurosurgeon Dr. Frederick Gutman, performs minimally invasive endoscopic surgery to treat pituitary tumors. This leading-edge approach offers patients considerable advantages over conventional surgery, such as faster recovery, less pain, and no cosmetic problems.
Commenting on the advent of endoscopic pituitary tumor removal, Dr. Samara says, "We've been using the same endoscopic techniques in sinus surgery for years, and these techniques have been progressing to allow us to treat nasal and eye problems; this was the next logical progression."
Benefits of Endoscopic Surgery For
Removing Pituitary Gland Tumors
l Elimination of cosmetic problems
l No incisions in nose or under lip
l Less pain or discomfort after surgery
l Post-op nasal packing generally not needed
l No need for placement of head-holder pins
l Significantly shorter procedure duration
l No need for placing large retractor in nose
l Reduced likelihood of scarring in nose
l No radiation used during the procedure
l Better view of tumor cavity for surgeons
The pituitary gland, sometimes called the master gland because it controls the functioning of several other endocrine glands, is a small, pea-sized endocrine gland at the base of the brain. Located about 3-4 inches behind the top of the nose, it produces several different hormones that are important in the function of the body.
Although tumors of the pituitary gland are generally benign and do not spread to the rest of the body, they can create multiple functional problems, including blindness and pressure on the brain.
In the past, pituitary tumors were removed using approaches either through the nose or by making a large incision under the upper lip and connecting it into the nose. Then a large retractor would be placed in the nose to keep it wide open for the surgery to be performed with a microscope.
These older approaches have the side effect of causing a cosmetic change in the appearance of the nose or leading to difficulties in breathing through the nose. Not only that, the scarring that develops under the lip after conventional surgery may cause difficulties with eating and other problems.
What It Is
Now the start-of-the-art approach to the pituitary gland is the endoscopic approach. Instead of the large incisions or the approaches through the nose, a thin flexible endoscope — just over an eighth (⅛) of an inch in thickness — is placed through the nose to open the sphenoid sinus (the sinus in front of the pituitary gland).
A computer is used to track the location of the instruments and to give the surgical team an extra margin of safety in locating and opening the sphenoid sinus.
Instruments are used through both nostrils and the tumor is removed under the magnified view of the endoscope. One of the advantages of this approach is the ability to place an angled endoscope within the tumor cavity and to see areas behind ledges not always possible with the conventional approaches using a microscope.
The minimally invasive surgery generally takes 1-2 hours — versus 3-4 hours with the older approaches. The patient generally has much less pain and discomfort. Most patients can go home in a couple of days post-op.
The endoscopic approach also avoids the use of the Mayfield head-holder (pins placed in the head to keep it still), as well as the use of x-rays and radiation during surgery, which were required in the past with the older operations.
Our performing minimally invasive endoscopic surgery for removing pituitary gland tumors further reflects our commitment to excellence in patient care at Stony Brook.