62165 Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach

Name of the Procedure:

Neuroendoscopy, Intracranial; with Excision of Pituitary Tumor, Transnasal or Trans-Sphenoidal Approach

Summary

This procedure involves the removal of a pituitary tumor using a minimally invasive technique that accesses the tumor through the nose and sphenoid sinus using an endoscope.

Purpose

This surgery is designed to remove pituitary tumors, which can affect hormone levels and cause a range of symptoms. The primary goal is to eliminate the tumor, alleviate symptoms, and restore normal hormonal balance.

Indications

• Symptoms such as headaches, vision problems, and hormonal imbalances.
• Diagnosis of a pituitary tumor via imaging studies (MRI, CT scans).
• Tumors that are accessible through the transnasal or trans-sphenoidal route.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustment or discontinuation of certain medications as directed by the physician.
• Pre-operative imaging tests and blood work.
• Detailed consultation with the surgical team to discuss the procedure, risks, and goals.

Procedure Description

1. The patient is placed under general anesthesia.
2. An endoscope is inserted through the nostril to reach the sphenoid sinus.
3. Specialized surgical instruments are guided through the endoscope.
4. The surgeon navigates to the pituitary gland, carefully removing the tumor.
5. The surgical site is inspected and any necessary repairs are made.
6. The endoscope and instruments are removed, and the nasal cavity is packed with gauze to manage bleeding.

Duration

Approximately 2 to 4 hours, depending on the complexity.

Setting

Performed in a hospital operating room equipped with neuroendoscopy technology.

Personnel

• Neurosurgeon
• Otolaryngologist (ENT specialist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Cerebrospinal fluid (CSF) leak
• Damage to surrounding structures, including the optic nerves
• Hormonal imbalances requiring lifelong medication

Benefits

• Minimally invasive with fewer incisions and quicker recovery times.
• Reduced risk of complications compared to traditional open surgery.
• Effective removal of the tumor, leading to symptom relief.

Recovery

• Short hospital stay (typically 1-2 days).
• Nasal packing is usually removed within a few days post-surgery.
• Avoid strenuous activity for several weeks.
• Follow-up appointments to monitor healing and hormone levels.
• Patients may resume normal activities gradually, based on doctor's advice.

Alternatives

• Medication management: for smaller tumors or inoperable cases.
• Radiation therapy: if surgery is not viable or for residual tumor tissue.
• Observation: in cases where the tumor is small and asymptomatic.

Patient Experience

The patient will be under general anesthesia during the procedure and will not feel anything. Post-procedure, there may be nasal congestion, mild pain, or discomfort managed with pain medications. Full recovery usually occurs within a few weeks, and patients are closely monitored for any changes in vision or hormone levels.