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Advances in technology such as the endoscope, surgical microscope and image guidance systems have led to major advances in pituitary surgery. Minimally invasive pituitary surgery that allows for precise removal of tumors in or around the pituitary gland also leads to faster recoveries, little or no scarring and fewer complications.
The pituitary gland is located in a hollow in the sphenoid bone called the sella turcica at the base of your brain. (The sphenoid bone separates your sphenoid sinus from your brain. The sphenoid sinus is a bony cave is located above the roof of the mouth behind the nose.) There is a direct path to the sella turcica through the sphenoid sinus.
Transphenoidal Pituitary Surgery
Transphenoidal surgery is a way of operating on the pituitary gland by going through the sphenoid sinus. This approach can be used for pituitary tumors and other types of tumors near the pituitary gland.
There are several ways to do transphenoidal surgery:
- Sublabial approach. This type of pituitary surgery goes through the upper lip to open a path between the hard palate in the roof of the mouth and the nose. Sublabial pituitary surgery is probably the most common approach used today.
- Endonasal approach. This type of pituitary surgery goes through the back of the nostril.
Sublabial Approach to Pituitary Surgery
Sublabial transsphenoidal surgery is relatively painful. It almost always causes numbness in the upper gums after surgery. It can also cause problems with the structures under the nose. An alternate form of this surgery involves small insucisions made in the nose itself. This avoids the lip numbness. It is similar in methods and side effects otherwise.
After surgery, the nose is packed with gauze for one to three days.
Endonasal Approach to Pituitary Surgery
Endonasal transsphenoidal surgery goes directly through the back of the nose, making a hole to reach the pituitary tumor. It is quick, safe and very comfortable for the patient. In the hands of an experience pituitary surgeon, it offers access to the entire pituitary area.
Only rarely is it necessary to pack the nose with the endonasal approach. This makes the patient more comfortable and means shorter stays in the hospital. There are no visible scars from this approach.
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