Pituitary adenoma: the surgery
To deal with this benign pituitary tumor it is often necessary to foresee a surgery, unless it is a pituitary adenoma that secretes prolactin or growth hormone. In such cases, simple follow-up or drug therapy, possibly accompanied by radiation therapy, may be sufficient.
Since the patient's well-being also depends on the timing and methods of recovery, the least invasive types of intervention possible are preferred. Among these, the transnasal transsphenoidal endoscopic surgery.
Transnasal transsphenoidal endoscopic surgery
This minimally invasive technique It allows access to the pituitary adenoma through the nasal cavity and the sphenoid bone, the characteristic butterfly-shaped bone located at the base of the skull. An endoscope is inserted, allowing visualization of the interior of the cavity, and the surgical instruments that will remove the adenoma. Therefore, no incision is necessary. on the face or skull to achieve the goal.
The final aim of the operation is in fact the most thorough removal possible of pituitary adenoma without affecting the functionality of the pituitary gland, endocrine gland essential to the organism, or damage the optic nervesImmediately after surgery, the adenoma is analyzed in the laboratory to fully understand its nature.
Explanatory video of endoscopic pituitary surgery (in French)
Thanks to Dr. Martin Dupuy, neurosurgeon colleague of the neurosurgery department of the Clinique de l'Union (Toulouse, France), for making and sharing this video.
https://www.neurochirurgie-union.com/dr-martin-dupuy/
After surgery: progress and complications
The intervention is a little painful and the primary, but in any case temporary, side effect is the perception of having a cold: a stuffy nose, a mild headache, and nasal discharge.
In the absence of particular complications, Hospitalization is on average 4-5 daysIn some cases, the surgery may be followed by radiation therapy.
As with any surgical procedure, there may be risks associated with transnasal transsphenoidal endoscopic surgery. General risks include: infection, bleeding, phlebitis, pulmonary embolism, and allergic reactions to the anestheticThe specific risks for this procedure are:
- cerebrospinal fluid fistulaThis occurs when fluid from the meninges around the brain leaks through the opening created during surgery. It can be identified in the days immediately following the procedure: a clear fluid that can easily be mistaken for water flows from the nostrils. In these cases, further surgery is rarely performed, and a lumbar puncture may be appropriate. At the end of the operation, to prevent this eventuality, the meninges are carefully closed, sometimes also by harvesting fat from the abdomen or thigh.
- pituitary insufficiency: if the pituitary gland no longer produces one or more hormones, drug replacement therapy is necessary, which may also become permanent.
- diabetes insipidus, a rare metabolic disorder that manifests itself with impaired thirst regulation and urine production. It occurs when the posterior portion of the pituitary gland is damaged and may require replacement therapy.
- meningitis: this infection is secondary to a meningeal rupture and is usually treated with specific antibiotics
- visual disturbances: if the pituitary adenoma has compromised the optic nerve, vision may be affected
- epistaxis: Mucous membranes become irritated by the passage of surgical instruments, resulting in delayed nosebleeds. This is more common in patients with bleeding disorders or taking blood-thinning medications.
- sinusitis and infection of the nasal cavities
- vascular lesion, as the main arteries leading to the brain are particularly close to the area being operated on
It is treatable complications, although they naturally impact on hospital stay times.
What to do after surgery
After the operation, you can resume your regular activities. After 10 days, you must undergo a nasal cavity washing e for the entire next month some small things need to be done precautions:
- don't blow your nose
- don't sneeze with your mouth open
- avoid straining with the glottis closed
- don't put your head under water
- avoid environments where there is a lot of dust
To better monitor the post-operative course, it is recommended a first check-up after 3 months or at least within the following 6 monthsIn some specific cases, it's a good idea to undergo it even earlier. The visit includes:
- assessment of pituitary gland function with the support of an endocrinologist
- magnetic resonance
- eye exam
