Neurosurgery Dr. Stoforou – Δρ. Κωνσταντία Στοφόρου – Νευροχειρουργός MD – PhD

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ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL PITUITARY SURGERY MIS AND ENDOSCOPIC PITUITARY SKULL BASE SURGERY MIS

Transsphenoidal access (MIS, minimally invasive surgery: endoscopic endonasal transsphenoidal pituitary surgery MIS and endoscopic pituitary skull base surgery MIS, endoscopic intranasal access, endoscopic patented pituitary tumor removal, pituitary tumor removal, cervical surgery) is used to remove tumors in the area of the pituitary, suprasellar region and sphenoidal cavity. The surgeon reaches this area through the nose. Endoscopic intranasal access can be done either with a microscope but now the use of the endoscope allows us to remove these tumors with minimally invasive technique, without incision in either the mouth or nose, with greater precision, better visual approach and safety. Pituitary tumors can cause various problems for the patient, depending on whether they are secreting hormones, or are pushing optic nerves or large vessels in the area. If this is the case, surgery for tumor removal is necessary.

What is endoscopic endonasal transsphenoidal pituitary surgery MIS and endoscopic pituitary skull base surgery MIS (minimally invasive surgery)?

Εndoscopic endonasal transsphenoidal pituitary surgery MIS and endoscopic pituitary skull base surgery MIS (minimally invasive surgery) is the surgical procedure performed through the nose and the sphenoidal cavity, which is located just behind the base of the nose and leads to the pituitary gland. Transsphenoidal surgery can be performed with a microscope, an endoscope, or both. This procedure is done in collaboration by a Neurosurgeon and an Otorhinolaryngologist. The old method purely by the microscope requires a cut under the upper lip of the mouth or into the nose, as well as the partition of a large part of the nasal septum so that the surgeon has a relatively wide but always limited field to perform the surgery . Endoscopic intranasal access (Εndoscopic endonasal transsphenoidal pituitary surgery MIS) uses a small incision at the back of the inside of the nose without dislodging the nasal septum. In the initial phase, the ENT surgeon through it reaches the sphenoidal cavity and then the Turkish sella where the pituitary gland is located. Then, as long as we are in the intracranial cavity, the Neurosurgeon undertakes, making the opening of the dura mater and removing the tumor in the pituitary.

What are the advantages of purely endoscopic transsphenoidal access MIS (minimally invasive surgery) in relation to old microscope access?

The main advantages of the endoscope are:

  • Better view of the surgical field.

The endoscope has the ability to provide vision in difficult areas to facilitate better and fuller removal of tumors.

  • Fewer complications.

At the same time, due to better vision, you can avoid complications and damage to tissues and blood vessels in the area that are not visible by the microscope. This is an advantage because it minimizes the morbidity from manipulation of these elements, resulting in fewer complications and thus shortening the hospitalization time.

  • Better aesthetic result,
    and postoperative nose restoration because there is no distortion of the nose and no nasal splints are needed postoperatively.

Who is a candidate for endoscopic endonasal transsphenoidal pituitary tumor removal surgery MIS (minimally invasive surgery)?

Candidates for endoscopic endonasal transsphenoidal microsurgery MIS are patients with:

  • Pituitary adenoma, which is a tumor that either secretes or not hormones produced by the pituitary gland.
  • Craniopharyngioma, a benign tumor originating from cells near the pituitary stem and may extend to the third ventricle of the brain.
  • Rathke’s Cust, a benign cyst that contains fluid and is found between the pituitary lobes.
  • Meningioma, a tumor originating from the meninges of the brain, that is, the membranes that surround and protect the brain and the spinal cord
  • Chordoma, a malignant bone tumor that develops from the remains of the embryonic spinal cord and is located at the base of the skull.
  • Rhinorrhoea, ie nasal discharge of cerebrospinal fluid.

Who is the appropriate surgeon to perform endoscopic endonasal transsphenoidal pituitary surgery MIS and endoscopic pituitary skull base surgery MIS (minimally invasive surgery)?

The team that is in close and full cooperation consists of Neurosurgeon and Otolaryngologist. The Neurosurgeon is responsible for the patient, the sellar and intracranial phase of surgery and for tumor removal. However, the intranasal phase of the surgery is performed by the ENT specialist who is specialized in endoscopic surgery of sinus cavities, as well as for postoperative monitoring of the nose.

 

What should be done before the endoscopic endonasal transsphenoidal pituitary surgery MIS and endoscopic pituitary skull base surgery MIS (minimally invasive surgery)?

The patient must be examined by an Endocrinologist, Ophthalmologist and ENT specialist in order to have a complete knowledge of his or her condition and thus propose an appropriate approach to his or her problem. The Neurosurgeon will explain the procedure, benefits and potential dangers of the surgery and will answer all the questions that may arise.