What is endoscopic pituitary surgery?

Endoscopic pituitary surgery is the most common surgery used to remove pituitary tumors. It's called transsphenoidal endoscopic surgery when the surgery is done through the nose.

Your pituitary gland is at the bottom of your brain and above the inside of your nose. It controls most of your body's hormones. Hormones are the chemical messengers that travel through your blood. They control many of the ways your body works.

Endoscopic pituitary surgery is done with a tool called an endoscope. It's a thin, rigid tube that has a microscope, light, and camera built into it. It's put in through your nose. The camera lets your surgeon watch on a screen while using other special tools are used to take out the tumor.

Why might I need endoscopic pituitary surgery?

Endoscopic pituitary surgery is done to remove certain types of tumors that start to grow in your pituitary gland, including:

  • Hormone-secreting tumors. These growths make hormones. They may be called functioning tumors.
  • Nonhormone-secreting tumors . These growths are also called endocrine inactive pituitary adenomas or nonfunctioning tumors. They're removed because as they get bigger, they may cause headaches and vision problems.
  • Cancerous tumors. These growths are very rare, but they are cancer and can spread to other parts of the body. They may be treated with a combination of surgery, medicines, and radiation treatment.

What are the risks of endoscopic pituitary surgery?

Most people have congestion and a headache for a few weeks after endoscopic pituitary surgery. But overall, it's safe when done by an experienced neurosurgeon.

Still, all surgery has some risk of reactions to anesthesia, bleeding, and infection. Other risks and complications of endoscopic pituitary surgery include:

  • CSF rhinorrhea. CSF (cerebrospinal fluid) is the fluid that surrounds the brain and spinal cord. It may leak from the nose after surgery. In some cases, you may need another surgery to repair this leak.
  • Meningitis. This is infection and inflammation in the membrane that lines the brain and spinal cord. It's more common if the CSF leaks. Antibiotics are given during and after surgery to help prevent this.
  • Damage to the pituitary gland. Damage to healthy parts of the pituitary that make hormones may be lasting (permanent). Hormone replacement may be needed after surgery.
  • Diabetes insipidus. Damage to the part of the pituitary that helps control urination may lead to frequent urination and thirst. This is common right after surgery and may get better over time. If it doesn't, you may need hormone replacement therapy. (Diabetes insipidus is not linked to blood sugar problems. That's type 1 or 2 diabetes mellitus.)
  • Severe bleeding. Heavy and ongoing bleeding into the brain or from the nose may happen if a large blood vessel is damaged during surgery.
  • Vision problems. The nerves that supply vision are close to the pituitary gland and can be damaged. This is rare.

Risks tend to be higher with big tumors and those that have grown into nearby tissues. You may have other risks depending on your health condition. Discuss any concerns with your healthcare provider. Talk about possible risks so you know what to expect.

How do I get ready for endoscopic pituitary surgery?

You may need to see an endocrinologist before surgery. These doctors are medical specialists who deal with glands and hormones. Your vision might also be checked before surgery.

Endoscopic pituitary surgery is often done under general anesthesia. This means drugs are used to put you in a deep sleep during surgery. You won't know what's happening and won't feel pain.

Follow any directions you are given for not eating or drinking before surgery. Tell your providers about any over-the-counter medicines, vitamins, herbs, or supplements you take. You may need to stop taking some of these before surgery.

You may have blood tests, a heart rhythm test (ECG), and a chest X-ray done before surgery. These are used to get an idea of your overall health and be sure you are well enough to have anesthesia and surgery. You'll need to be examined by the doctor or nurse who gives the anesthesia, too.

What happens during endoscopic pituitary surgery?

The surgery may take a few hours. Many times, an ear, nose, and throat (ENT) specialist will work with your neurosurgeon. Here's an overview of what may take place:

  • The ENT surgeon usually puts the endoscope through your nose. In some cases, the endoscope may be put through a cut (incision) that's made under your upper lip and above your teeth.
  • The endoscope is moved until the bony wall of the sphenoid sinus is found at the back of your nose.
  • The sphenoid sinus is opened with long, thin tools. Then the surgeon passes the scope through to the back wall of the sinus.
  • The surgeon makes a small opening in the back wall of the sinus to get to the pituitary gland. MRI may be used to make images to help guide the surgeons.
  • When the pituitary area is reached, the neurosurgeon removes the pituitary tumor in small pieces.
  • When all parts of the tumor that can be reached have been taken out, the endoscope is removed.
  • Packing may be put in the nose to complete the surgery.

What happens after endoscopic pituitary surgery?

You may need to stay in the hospital for a day or two. You'll be able to eat a normal diet as long as you are taking fluids well. You'll be encouraged to get out of bed and walk as soon as you are able. While in the hospital, you'll be asked to help your nurses keep track of the amount of fluids you drink and how much urine you are making. This helps your healthcare team see how your pituitary is working.

Care at home may include:

  • Pain medicine to control headaches, the most common problem after surgery
  • Restricted activities. Don’t lift or strain until cleared by your surgeons.
  • Follow-up visits with your endocrinologist and surgeons
  • Repeat MRI
  • Vision testing

It’s important to let your surgeons know about:

  • Any headache that doesn't go away with medicine
  • Nausea and vomiting
  • Fever
  • Bleeding from the nose
  • Watery discharge from the nose
  • Increased urination

Talk with your healthcare providers about what symptoms to watch for and when to call them. Make sure you know what number to call with problems or questions. Is there a different number for evenings and weekends?

Next steps

Before you agree to this surgery make sure you know:

  • The name of the surgery
  • The reason you are having the surgery
  • The risks and benefits of the surgery
  • What the possible side effects or complications are
  • When and where you are to have the surgery
  • Who will do the surgery and what that person’s qualifications are
  • What would happen if you did not have the surgery
  • Any alternative surgery to think about
  • Who to call after surgery if you have questions or problems
  • How much you will have to pay for the surgery