Leading the way in minimally-invasive endoscopic pituitary surgery
At NYU Winthrop, endoscopic pituitary surgery is a dual-surgeon procedure involving a neurosurgeon and an otolaryngologist, who begins the procedure by carefully threading an endoscope into the sphenoid sinus to the roof of the sphenoid, which is also the floor of the pituitary. The main indications for the surgery are either uncontrolled symptoms of endocrinologically active tumors, such as those causing acromegaly or Cushing’s disease or symptoms associated with compression of surrounding anatomy. The goal is to reduce pressure on nearby structures and/or normalize hormone levels.
The most common pituitary growth – adenomas – are divided into secretory lesions, which give rise to hormonal disturbances caused by hypersecretion, and non-secretory growths, which do not usually present until reaching a size sufficient enough to cause pituitary dysfunction or compress surrounding neural structures such as optic nerves. When this happens, symptoms can include compromised vision and headaches.
Optimal pituitary tumor removal has progressed from traditional craniotomy to the transsphenoidal approach using less invasive endoscopic endonasal surgery. Employing an endoscope with the latest image-guidance neuronavigation technology is a safe and effective way to remove even very large tumors.
The small fiberoptic-like endoscope used in the innovative procedure is only 4 mm in diameter with angled lenses and a camera on its tip, which brings the viewing lens close to the work area and provides unparalleled illumination, magnification and high optical resolution of the surgical field. The image is projected onto a video monitor, and the extraordinary visualization even allows for treatment of tumors sometimes considered inoperable by traditional surgery.
This minimally invasive approach is well tolerated by patients and has several benefits. Since the point of entry is through the natural pathway of the nostril, there is no need for sublabial incisions. Therefore, there is less swelling and discomfort after surgery. Risk and patient morbidity are reduced, bleeding and post-operative pain are minimized, length of hospital stay is shortened and recovery is easier.