Name of the Procedure:

Hypophysectomy (Excision of Pituitary Tumor) - Transnasal or Transseptal Approach, Nonstereotactic

Summary

Hypophysectomy is a surgical procedure to remove a tumor from the pituitary gland by accessing it through the nasal passages. This method avoids the need for a craniotomy (opening the skull) and typically involves either a transnasal (through the nostrils) or transseptal (through the nasal septum) approach. It is a nonstereotactic procedure, meaning it does not use external devices to map the brain for guidance.

Purpose

This procedure aims to treat pituitary tumors, which can cause a range of hormonal imbalances and symptoms. The primary goals are to remove the tumor, alleviate symptoms, restore normal pituitary function, and prevent further complications.

Indications

• Symptoms such as vision problems, headaches, and hormonal imbalances caused by pituitary tumors
• Pituitary adenomas (benign tumors)
• Cushing's disease
• Acromegaly
• Non-functioning pituitary tumors causing compression effects

Preparation

• Patients may need to fast for a specific period before the procedure.
• Medication adjustments, such as stopping blood thinners.
• Preoperative imaging studies like MRI or CT scans to locate and assess the size of the tumor.
• Blood tests to evaluate overall health and hormonal levels.
• Consultation with an endocrinologist may be required.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Nasal Access: The surgeon inserts instruments through the nostrils or creates an incision in the nasal septum to access the sphenoid sinus.
3. Tumor Removal: Using specialized instruments, the surgeon removes the pituitary tumor.
4. Closure: The surgical site may be packed with absorbable materials to control bleeding, and the nasal passages are then closed.
5. Postoperative Care: The patient is monitored as they wake up from anesthesia.

Duration

The procedure typically takes about 1.5 to 3 hours.

Setting

It is generally performed in a hospital operating room.

Personnel

• Neurosurgeon
• Otolaryngologist (ENT specialist)
• Anesthesiologist
• Surgical nurses
• Scrub technicians

Risks and Complications

• Bleeding
• Infection
• Cerebrospinal fluid leak
• Damage to surrounding structures, such as the optic nerves
• Hormonal imbalances requiring lifelong medication
• Short-term nasal congestion and discomfort

Benefits

• Relief from symptoms caused by the tumor, such as headaches and visual impairment
• Potential normalization of hormone levels
• Prevention of further tumor growth and related complications
• Improvement in quality of life

Recovery

• Hospital stay for 1-2 days for monitoring
• Nose may be congested or require rinsing to clear
• Follow-up appointments to monitor recovery and hormonal function
• Avoid heavy lifting and strenuous activities for several weeks
• Full recovery may take a few weeks to a couple of months

Alternatives

• Medication to control hormone production (though it might not shrink the tumor)
• Radiation therapy
• Observation with regular MRI scans if the tumor is small and not causing symptoms

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Postoperatively, the patient may experience nasal congestion, mild discomfort or pain, and fatigue. Pain is typically managed with prescribed medications and rest. Most patients can return to normal activities gradually over several weeks, with some temporary restrictions on activities.