Pituitary Gland Surgeries

Overview of Pituitary Tumors

Pituitary tumors are benign, non-cancerous tumors in most cases, with the percentage of cancerous tumors in the pituitary gland being less than 1%. Pituitary tumors cause similar symptoms. A large pituitary tumor can press on the optic nerves and affect vision. It can also cause damage to the surrounding normal pituitary tissue and a deficiency in some or all of the hormones secreted by the pituitary gland.

Rarely does a pituitary tumor produce hormones abnormally, but the most common is a tumor that secretes prolactin hormone. Some other pituitary tumors produce steroid hormones or growth hormones.

Pituitary Gland Surgeries and Their Indications

Most pituitary gland surgeries are performed through the nose, allowing surgeons to easily access the pituitary gland without causing significant harm to the patient.

The doctor usually decides to perform pituitary gland surgery if the tumor is benign but causes problems affecting other aspects such as:

• Pressure on the optic nerve, causing vision impairment.
• Abnormal hormone secretion rates, sometimes the tumor leads to excessive secretion.
• If the tumor reduces hormone levels in the body due to pressure on the pituitary gland.
• Bleeding in the pituitary gland, due to tumor pressure on the gland.

Post-surgical results usually depend on the type of pituitary tumor, its size and location, and whether the tumor has grown into surrounding tissues or not.

Surgical procedures for removing a pituitary tumor include:

1. Endoscopic transnasal transsphenoidal surgery
2. Transcranial surgery

Endoscopic transnasal transsphenoidal surgery

This surgery is also known as pituitary adenectomy. It is the most common procedure for removing a pituitary tumor.

During the surgery, a neurosurgeon, in collaboration with an ENT surgeon, removes the tumor through the nose and sinuses.

Its advantages:

• The surgery does not require an external incision.
• This surgery does not affect other parts of the brain.
• It does not leave a visible scar.

Large tumors can be difficult to remove with this surgery, especially large tumors that have spread to adjacent nerves, blood vessels, or other parts of the brain.

Steps of Endoscopic transnasal transsphenoidal surgery

The endoscopic transnasal transsphenoidal surgery is performed in the following steps:

1. The patient is anesthetized and prepared for surgery.
2. An ENT surgeon usually inserts the endoscope through the nose; in some cases, it may be inserted through an incision under the upper lip.
3. The endoscope is advanced until it reaches the bony wall of the sphenoid sinus at the back of the nose.
4. The sphenoid sinus is opened, and the endoscope is passed through it to the posterior wall of the sinus.
5. A small opening is created in the posterior wall of the sinus.
6. MRI imaging can be used to create images of the pituitary area during surgery to help guide surgeons.
7. After entering the pituitary area, the neurosurgeon removes the pituitary tumor in small pieces.
8. When the tumor removal is complete, the endoscope is withdrawn, and some packing is placed in the nose to complete the procedure.

It’s worth noting that these steps may vary depending on each patient’s condition and the instructions of Professor Dr. Yousre and his team of surgeons.

Transcranial surgery

Transcranial surgery or craniotomy is one of the types of pituitary gland surgeries and is a surgical procedure used less frequently than endoscopic transnasal transsphenoidal surgery in treating pituitary tumors.

Its advantages:

• This surgery is used to facilitate access to and removal of large tumors or tumors that have spread to adjacent nerves or brain tissues.
• This surgery makes it easier for the surgeon to see the extent of the tumor, as well as the surrounding parts of the brain.

Steps of Transcranial Surgery

During transcranial pituitary gland surgeries, the surgeon removes the tumor through the top of the skull through an incision in the scalp, and the steps are as follows:

1. The patient is initially given general anesthesia. After that, the patient is positioned on the operating table, and the scalp skin behind the hairline is cleaned and prepared.
2. The access site is determined either through the forehead or the side of the head. A small part of the hair may be shaved if necessary, and the skin and superficial muscles are cut to access the skull.
3. A craniotomy is performed to remove a part of the skull and access the brain.
4. After opening the skull, the membrane lining the brain is cut and lifted to access the brain tissues.
5. The brain is gently lifted to create a safe path to the pituitary gland without causing injuries.
6. The tumor is located and carefully removed away from surrounding structures.
7. After removing the tumor, it is ensured that there is no active bleeding, then the wound is carefully closed in layers with the original part of the skull replaced.
8. The muscles and scalp are approximated and secured with sutures to facilitate the healing process.

The transcranial approach is considered a rarely used surgical procedure and is preferred in cases of large pituitary tumors that show complex growth.

Post Pituitary Gland Surgeries

After pituitary gland surgery, post-operative care is provided to the patient to accelerate the recovery process and ensure the desired results are achieved. Usually, the post-pituitary gland surgery phase proceeds as follows:

• Monitoring the patient’s vital signs in the recovery room while regaining consciousness from anesthesia, this is done to ensure their condition is stable.
• The patient may be transferred to a regular room or intensive care unit for close follow-up and monitoring, especially in more complex surgical cases.
• Dealing with potential surgical symptoms such as nausea and headache, and appropriate treatment is given to alleviate these symptoms.
• The patient may have a compounded psychological experience after surgery, and psychological and emotional support should be provided to help them adapt to physical and psychological changes.
• Continuing follow-up with the multidisciplinary medical team to ensure the condition is stable and compensate for any deficiency in the body’s natural hormones.
• The patient must follow all medical instructions provided by the medical team, including home care, dietary advice, and physical exercise after surgery.

The patient must adhere to all guidelines and advice provided by Professor Dr. Yousre and the rest of the medical team to ensure a successful recovery process and a quick return to normal life.

Best Doctor for Pituitary Gland Surgeries in Egypt

Professor Dr. Yousre Anwar El-Hemyly – Professor in the Department of Neurosurgery and Spine Surgery at the Faculty of Medicine, Cairo University – and his assisting medical team have gained an excellent reputation as the best doctor in the field of neurosurgery and spine surgery, for the following reasons:

• Dr. Yousre and his medical team are distinguished by their extensive experience in the field of pituitary and nerve surgeries.
• Dr. Yousre relies on his strong scientific background and in-depth practical training in providing surgical care.
• He is characterized by skill and precision in performing surgical operations, making him an ideal choice for patients who need surgical treatments for the pituitary gland.
• Professor Dr. Yousre and his team care for each patient individually, and always strive to meet their health needs in a personal and specialized manner.
• Thanks to their proficiency and attention to detail, Dr. Yousre and his medical team are considered a reliable and recommended choice for patients seeking safe and effective pituitary gland surgeries.

If you want the exceptional expertise and care provided by Professor Dr. Yousre Anwar El-Hemyly in pituitary gland surgeries, book your consultation today and start your journey towards healing.