Skull Base Neurosurgery

Series 2. Pituitary Tumour (adenoma)

What is Endoscopic Transsphenoidal Surgery?
In the early part of the 20th century, Harvey Cushing proposed approaching the pituitary gland directly through the nose. In order to gain access to the pituitary fossa, one needs to first penetrate the sphenoid sinus (air-filled cavity in the bone of the skull base).......hence, "trans-sphenoidal". This was previously performed using the microscope which provided a good view but was limited by the relatively long and narrow corridor through which the surgeon had to operate. The endoscope allows a better view of the target organ by increasing the illumination, magnification and field of view (see. Brain Tumours - Series 4). As an added bonus, the endoscopic technique reduces the potential nasal complications and post-operative discomfort.

This is the preoperative scan of a lady with visual problems, who was found to have a pituitary tumour. These are commonly "adenomas" which are mostly benign tumours that can be cured with surgery. Sometimes they can be treated with medication, although this is never curative. The common surgical approach is through the nose or transsphenoidal. When done using conventional technique, patients have considerable post-op discomfort and can experience long-term complications such as nasal perforations, numbness of the teeth etc.

This lady had her tumour removed using minimally invasive endoscopy, had no post-op complications, claimed her vision was better and was discharged from hospital within 24 hours of surgery.