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Endoscopic Pituitary Tumor Removal: What to Expect

Endoscopic Pituitary Tumor Removal: What to Expect

Each year in the United States, more than 10,000 people find out they have an abnormal growth on their pituitary gland. Most of these pituitary tumors are benign (noncancerous) growths called pituitary adenomas; very few are pituitary carcinomas, or malignant growths with the potential to spread and invade other tissues.    

Although small benign pituitary tumors often remain undetected and harmless, it’s imperative to remove cancerous pituitary growths as well as benign pituitary tumors that cause hormonal imbalances, vision problems, and other bothersome symptoms. 

As a fellowship-trained neurosurgeon who specializes in endoscopic pituitary tumor removal, Jose Valerio, MD, uses an advanced, minimally invasive procedure that doesn’t require visible incisions or a lengthy recovery. Here’s what to expect. 

A short tutorial on pituitary adenomas  

As “the master” of your endocrine system, your pituitary gland is a tiny organ at the base of your brain. Its main function is to make and release hormones that regulate the hormones produced by other endocrine glands, including the thyroid, parathyroid, and adrenal glands. 

Many benign pituitary tumors remain small, stable, inactive, and undetected for life. In fact, based on post-mortem brain scans and other MRI results, researchers surmise that up to one in four people live with a harmless pituitary adenoma that isn’t causing symptoms. 

An otherwise harmless pituitary adenoma can become problematic, however, if it changes. Dr. Valerio recommends endoscopic pituitary tumor removal for active “functional adenomas” that make and release hormones, as well as for larger “macroadenomas” that put pressure on nearby brain structures. 

Endoscopic pituitary tumor removal

First, Dr. Valerio inserts a small instrument called an endoscope through one nostril and threads it to the location of the pituitary tumor. The endoscope’s sophisticated viewing lens gives Dr. Valerio a high-resolution, magnified view of the tumor and nearby structures.

Then, he inserts a specialized microsurgical instrument through the other nostril and threads it to the pituitary tumor to dissect and remove the tumor. In the following, Dr. Valerio provides a more thorough explanation of the procedure.

Before your surgery  

In the days leading up to your procedure, Dr. Valerio explains what to expect during surgery and outlines the procedure’s benefits and risks. After a complete review of your medical history and current health status, he may recommend:

Pituitary removal surgery is typically scheduled early in the day, as you shouldn’t eat or drink before the procedure. 

During the operation 

The procedure itself typically lasts 2-3 hours, and it’s completed in five basic steps:

1. Patient preparation

Endoscopic pituitary removal is done with the aid of general anesthesia. Once you’re asleep, our surgical team preps your nostrils and nasal cavity with an antibiotic/antiseptic solution.  

Next, we place an image-guidance system on your head. This small, GPS-like device helps Dr. Valerio navigate through your nostrils and nasal cavity using a 3-D “map” created from your CT or MRI scans.

2. Endoscope insertion and incision 

Next, Dr. Valerio inserts the endoscope into one nostril and advances it toward the back of your nasal cavity. With its light and tiny camera, the endoscope transmits high-definition images to a nearby video monitor.

Watching the monitor, Dr. Valerio passes a long, thin surgical instrument through the other nostril and uses it to remove a small portion of the nasal septum that keeps the left and right nostril separated. Then, he makes an incision in the front wall of the sphenoid sinus.     

3. Pituitary gland access 

The thin bony plate that covers the pituitary gland, called the sella, is located at the back wall of the sphenoid sinus. Dr. Valerio makes a small hole in the sella to expose the tough lining of the skull called the dura, then he opens the dura to expose the pituitary gland and its tumor. 

4. Tumor dissection and removal 

Then, Dr. Valerio uses a long grasping instrument to dissect and remove the tumor in pieces. By coring out the center of the tumor first, the tumor margins fall inward within easy reach. Once all visible portions of the tumor are cleared away, Dr. Valerio advances the endoscope to check for hidden tumor material.    

5. Repairing the sella

Next, Dr. Valerio repairs the hole in the sella with a bone graft obtained from your septum. If your septum is insufficient or you’ve had a previous pituitary tumor removal procedure, he uses synthetic graft material to repair the sella. The bone graft is held in place with biologic glue, which promotes healing and stops cerebrospinal fluid from leaking into the nasal cavity.   

Finally, Dr. Valerio places soft, flexible splints inside your nose, up along the septum, to control bleeding and minimize swelling. These splints also prevent adhesion formation during the healing process.

After the procedure 

Following your pituitary tumor removal, you may experience nasal congestion, nausea, and headaches. These short-term side effects can be eased with medication and further minimized by following Dr. Valerio’s post-surgical instructions.  

The day after your surgery, an endocrinologist may check your pituitary gland to ensure it’s producing the right levels of hormones. You can also expect to have a brain MRI before you’re discharged from the hospital.    

Your first post-surgical follow-up appointment takes place one week after your operation. Typically, patients attend 2-4 follow-up visits with Dr. Valerio to make sure the nasal cavity is healing as expected. You may also have a follow-up visit with an endocrinologist to determine if hormone replacement medications are necessary.   

Comprehensive care for your pituitary tumor

If you’ve been diagnosed with a pituitary tumor, Jose Valerio, MD, can help. To learn more about minimally invasive endoscopic pituitary tumor removal, schedule a visit at your nearest office in South Miami, Hialeah, or Weston, Florida, today.

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