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Pituitary Surgeries​

What is Pituitary Surgeries​ ?

In our centers, our surgeons perform pituitary surgery with three different approaches, based on the best possible outcome criteria. Surgeons would employ Endoscopic trans-sphenoidal surgery, Microscopic sublabial or Microscopic trans-nasal methods for pituitary surgery. Very rarely, open skull-based surgeries (craniotomy), such as supraorbital eyebrow may be performed.

Microscopic pituitary surgery is performed through the nose and sphenoid sinus to remove pituitary tumors. In this procedure, small incisions are made along the nasal septum or under the upper lip. Small surgical drills and other instruments are used to open the boney walls of the sphenoid tissues. Small tools guided by microscope are used to remove tumors.

InEndonasal endoscopic transsphenoidal surgery, an endoscope, a thin fiber-optic tube with a tiny camera at the tip is used to help perform surgery. A small incision is made in the back of the nasal septum. Instruments are passed through the nose and the sphenoid sinus. This approach affords a more panoramic and detailed view than the more restricted “tunnel vision” of a microscope.

The surgery usually takes 2-4 hours, in case the tumor is extending further into the intracranial space such as craniopharyngioma, it may take up to 8 hours. Once in an operating room, you would be anesthetized, positioned, and registration on the neuro-navigation system shall be done. The surgeons (sometimes ENT Surgeon), would reach your sphenoid sinus and thereafter the procedure shall include exposure of Sella and tumor removal. During tumor removal, care is taken to protect the critical surroundings structures such as optic nerves, chiasm, carotid arteries, pituitary gland and pituitary stalk. Once a tumor is removed, the tumor resection cavity is inspected thoroughly to confirm that all or maximum amount of tumor has been removed.


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Course In Hospital

Day 1

You are admitted. You will undergo Navigation Protocol MRI, hormonal tests, evaluation by an endocrinologist, a detailed visual examination with quantified visual fields, examination by the ophthalmologist and if you have vision loss or tumor compressing the optic nerve, you may undergo optical coherence tomography (OCT). Your investigation reports are studied and you are also made aware of the reports. You would be explained in detail about the surgery, its advantages, and complications. Pre anaesthetic check up (PAC) is done. Your consent for a procedure is undertaken.

Day 2

You are shifted to OT. You are given general anesthesia and thereafter the surgery is performed. Post-procedure, you would stay in ICU for 6-8 hours for observation. You would then be shifted to the regular hospital room. You can eat and sit upright. You may be allowed to stand and walk.

Day 3

You would be monitored in the hospital room for any nasal discharge. You would undergo an MRI.

Day 4

Your discharge summary would be prepared. You would be explained all the medications to be taken while at home. You would also be explained about the precautions to be undertaken for subsequent weeks. You are discharged from a hospital. You would be monitored in the hospital room for any nasal discharge. You would undergo an MRI.

Follow up

An assessment for blood sodium and cortisol levels is scheduled for approximately 5-7 days after surgery. Regarding physical activity, you would be instructed to avoid heavy lifting, bending over and blowing the nose for the first week after surgery.

You would also be instructed to perform routine post-operative nasal care including irrigation and nasal sprays and nasal lavage starting after 5th postoperative day. Airplane travel is generally allowed within 7-10 days of surgery.

Endocrinological evaluation is typically performed within 4-6 weeks following surgery.

You would also be encouraged to undertake long-term imaging follow-up for few years starting 3 months after surgery, followed by another one after 6-12 months and at a yearly interval for 5-7 years.

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