Endoscopic skull base surgery is a minimally invasive surgical procedure performed to remove tumors in and around the pituitary gland. The pituitary gland is the "master" gland which regulates many of the body's hormones. It sits at the base of the skull above the nasal sinuses. This location allows for direct access to tumors through the nose without the need for an external incision. While this approach has been performed for many years, recently the use of endoscopes, specialized instruments, and improved skull base closure techniques have revolutionized surgery in this region. The endoscope allows for improved visualization of tumors and normal structures using high definition cameras which bring the surgeon's eye to the problem.
When is Endoscopic Skull Base Surgery needed?
There are several types of tumors which arise from the tissue of the pituitary gland.
Hormone secreting adenomas: The pituitary gland secretes hormones and thus tumors can arise that secrete hormones as well. The overproduction of these hormones can cause a variety of symptoms affecting the entire body. The treatment of these tumors depends on a number of factors, with some tumors requiring surgery and others treated with medication alone.
Non-hormone secreting adenomas: These tumors don't secrete hormones and are benign. Small tumors can be safely followed with MRIs. However, larger or growing tumors may cause symptoms including visual loss, a decrease in hormone production, or headaches. These tumors often require surgery with radiation reserved for poor surgical candidates or patients with residual tumor within areas unsafe for removal.
Cancerous tumors: A combination of therapies are typically used to treat these tumors including surgery, chemotherapy, and/or radiation.
Tumors or cysts arising around the pituitary gland: There are a variety of other lesions which can arise within the region around the pituitary gland. The endoscope provides better visualization of the skull base deep within the nose and can offer a less invasive alternative than traditional resection techniques for selected tumors. If the tumor is large or more expansive, a craniotomy may be required.
Symptoms of a pituitary tumor may include:
- Vision loss
- Irregular menses
- Decrease libido
- Abnormal leakage of breast milk
- Coarsening or enlargement of hands, feet and face
- Low or high blood pressure
- Frequent urination
- Excessive thirst or hunger
- Excessive weight loss or gain
How does Endoscopic Skull Base Surgery Work?
Pituitary tumors are managed by a team of physicians including neurosurgeons, rhinologists, endocrinologists and ophthalmologists for comprehensive pre- and post-operative care of the brain, nose, hormones, and vision. Patients are cleared medically and undergo CT and MRI images for navigation during surgery. On the day of surgery, patients are brought to the OR and put to sleep by the anesthesiologist. Once prepared for surgery, a long, thin endoscope is advanced through the nose. The ear, nose, and throat physician opens the nasal sinuses and may raise specialized flaps in preparation for closure. The neurosurgeon then opens the skull base and removes the tumor. Pathological evaluation of the tumor is performed to determine the tumor type. Once removal of tumor is completed, the skull base is closed, and the endoscope is removed. Patients are observed in the hospital for several days after surgery for any hormonal or fluid imbalance.
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Endoscopic skull base surgery allows relief from pituitary tumors without the use of traditional “open” cranial surgery. Request more information about this treatment method today: contact us.