Home Discussion Forum How are tumors near and around the pituitary gland removed?

How are tumors near and around the pituitary gland removed?

List all surgical methods please.

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  1. Tumors of the pituitary gland are in a bony cup called the “sella turcica” which is located along the midline of the head, essentially straight back and slightly above the bridge of the nose. This anatomic location is surrounded by a number of stuctures that would be disasterous if injured during a surgical approach. The optic chiasm which is a central crossover point in the optic nerves, is located just in front of the pituitary, the cavernous sinus and the internal carotid arteries, which are major vascular structures, surround it to the front and sides, and the brainstem lies just behind it. Fortunately, there is one avenue of approach that is uniquely suited for pituitary surgery. This is from directly below.
    Pituitary tumors are removed surgically with excellent results and minimal discomfort to patients because just underneath the pituitary gland is a space called the sphenoid sinus. This is an air filled cavity that is in communication with the air spaces surrounding the nose.
    Surgical exposure of the pituitary gland and its tumors can be made by making an incision inside the mouth, behind the upper lip, and then entering into the nasal cavity. From this angle, the roof of the nasal cavity is exposed and the bone is opened there. Above this lies the sphenoid sinus. The roof of the sphenoid sinus is opened and on the other side lies the pituitary gland and any tumors within the sella turcica. Many of these tumors can be excised completely by way of this approach.
    The incision heals invisibly because it is within the mouth cavity.
    This is the modern approach to the pituitary gland. Other methods have been used in the past, but these were dramatically more invasive, more risky, and more difficult. Their results were intermixed with higher complication rates. The biggest impediment to success for the mordern “trans-sphenoidal” approach involves bulky tumors which extend up and out of the sella in a way that makes it difficult to obtain a complete tumor excision. Many tumors of the pituitary gland are “well circumscribed” meaning that they have smooth edges and can be peeled away from the surrounding normal tissue with relative ease. However, some of these tumors are truly invasive cancers and therefore a complete removal can be problematic.
    If you have specific questions about this procedure, or about types of tumors that arise from the pituitary, please feel free to contact me. I’d be happy to help with further information.

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