Pituitary tumors make up approximately 10% of intracranial tumors, and most secrete hormones that give away their presence. The most common type is the pituitary adenoma, a benign overgrowth of the anterior pituitary gland. Overgrowth into the nearby tissues, causing nerve or blood vessel compression, is the most common way that non-secretory tumors are diagnosed.
If a pituitary tumor is causing problems, it can be treated via medical, radiological or surgical techniques. Modern surgical techniques are minimally invasive while remaining extremely effective. Because of where in the brain the pituitary is located, it can be accessed through the nasal passages, which has many advantages over opening up the skull.
Endoscopes are used for many medical procedures these days. The tiny camera on the end of a piece of tubing allows doctors to see inside the body in a much less invasive manner than older options such as exploratory surgery. It has also allowed them to learn to perform surgeries without making large incisions, via tools placed through multiple smaller incisions. This ‘laproscopic’ or ‘keyhole’ method is used in many surgeries all over the body these days.
Pituitary tumor surgery has been especially effected by the advent of the endoscope. Before endoscopy was available, pituitary tumors were sometimes treated by opening the top of the skull in the conventional approach to brain surgery. This method is still occasionally necessary if the tumor is large or complicated, but has mostly been eliminated from use for smaller tumors.
The older transnasal approach had some of the advantages of endoscopic procedures, but did not allow full visualization of the tumor. This made is harder to remove all of the tissue, which could lead to a recurrence and continuing symptoms. Modern endoscopes get the camera right up next to the tumor, and the flexibility of the scope allows surgeons to visually explore the surgical site from many directions.
Entering through the nostril means that there is no external incision. The tiny endoscope and tools used to perform the surgery require no packing of the nasal cavity after surgery, and patients are often discharged within 24-48 hours. The brain itself is undisturbed by the surgery, which avoids many possible complications and side effects.
Recovery from endoscopic surgery is typically brief. Patients can get back to their normal lives relatively quickly, and tend to have few side effects. The fully endoscopic procedure was first performed in 1996, so many surgeons have a lot of experience and facility with the task at this point.
Modern medicine has worked hard to find the best approaches to treating many medical conditions. Pituitary tumor surgery was a prime candidate for the endoscopic approach, since visualizing the tumor was the main problem with accessing it transnasally. The endoscopic approach quickly became the gold standard of surgical treatment of this condition, and remains such to this day.