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Transsphenoidal Hypophysectomy

For patients who present with a pituitary gland tumor, Dr. Greenwald may suggest a procedure called Transsphenoidal Hypophysectomy. Designed to access the tumor through the nasal cavity, this surgery aims to achieve a favorable surgical outcome while avoiding as many vital brain structures as possible. As compared to open craniotomy, Transsphenoidal Hypophysectomy offers significantly faster recovery times and can reduce instances of serious side effects.

If you have been diagnosed with a pituitary tumor, please schedule an appointment with Dr. Greenwald. You can schedule a Transsphenoidal Hypophysectomy consultation by calling our office at (650) 968-4747, or email us through the Contact Form.

Why is Transsphenoidal Hypophysectomy Needed?

Transsphenoidal Hypophysectomy is performed in cases where a patient presents with a pituitary gland tumor. Such tumors can have a devastating effect on a patient’s health and well being if left untreated, including permanent blindness.

The pituitary is a small gland that is located at the base of the brain, and is situated behind the nasal cavity. Although it’s quite small (about the size of a pea), it has a pronounced effect on our bodies as it plays a major role in controlling other endocrine glands. The endocrine system is vital for the proper function of the body, as it secretes numerous hormones that control our biological functions such as metabolism, our sleep cycles, and much more.

However, sometimes the pituitary gland may develop a tumor, which is an uncontrollable growth of cells. As the tumor grows, it can cause a number of problems, because the pituitary gland is located next to a variety of crucial nerves and blood vessels.

For example, many patients first learn that they have a pituitary tumor while visiting their doctor for vision problems, as the tumor begins to press on the optic nerves. Others may learn of this problem if the tumor disrupts the function of the pituitary gland and causes a hormonal imbalance.

To address this problem, Dr. Greenwald may perform Transsphenoidal Hypophysectomy to remove the tumor and alleviate the associated symptoms.

How Transsphenoidal Hypophysectomy Works

Transsphenoidal Hypophysectomy was designed to effectively remove the pituitary gland tumor while reducing recovery times and the possibility of serious side effects.

The surgery will begin with general anesthesia, so that you will not feel any discomfort during the procedure.

Once the procedure starts, Dr. Greenwald will meticulously dissect the mucosa of the lining of the nasal cavity, and use special instruments and microscope to create a path to the sphenoid. The microscope has a small camera and light at the tip, which allows Dr. Greenwald to see the position of the surgical tools.

The pituitary gland is located behind sphenoid cavity, which is filled with air, and doesn’t have vital structures within it. Upon reaching the sphenoid cavity, Dr. Greenwald will remove a small portion of bone at the front of the sphenoid cavity, and maneuver the microscope and the surgical tools inside the cavity until its back wall, called the sella.

Dr. Greenwald will use the same surgical technique to remove the sella, which will expose the soft lining of the skull called the dura. With a tiny scalpel, the dura will be opened, making the pituitary gland and the associated tumor fully visible.

At this point of Transsphenoidal Hypophysectomy, the tumor removal can begin. To preserve as much healthy tissue as possible, Dr. Greenwald will remove the tumor in small sections, visually inspecting the treatment site every step of the way, before removing more sections of the tumor. This visual inspection is very important during Transsphenoidal Hypophysectomy, because the pituitary gland is located next to several vital nerves and blood vessels. Dr. Greenwald takes great care during the procedure to avoid these vital structures.

When tumor removal has been completed, Dr. Greenwald will begin the process of closing the area. (It’s important to note that full tumor removal may not be possible, depending on the location of the growth. Though even partial removal can significantly reduce the patient’s symptoms and increase the effectiveness of non-invasive tumor treatments that follow.)

As part of sealing off the treatment area during Transsphenoidal Hypophysectomy, Dr. Greenwald may insert a fat graft in front of the pituitary gland, and place a piece of bone cartilage in front of it. Thereafter, the area is sealed with a special glue.

Recovery After Transsphenoidal Hypophysectomy

After your Transsphenoidal Hypophysectomy procedure, you may be required to stay at the hospital overnight for monitoring. However, you will be able to start walking the evening of the procedure or the very next day.

During recovery, it is imperative to allow the area to heal completely. We often don’t realize what a huge role the nasal cavity plays in our lives. It is impacted every time we sneeze, blow our nose, or even bend down to pick something up. As part of the recovery process, however, these activities must be minimized as much as possible, so that the cartilage graft and the surrounding tissue has time to form strong connections and the growth can cover the surgical opening in the sphenoid sinus.

Further, to help the area heal and prevent future sinus problems, special splints are inserted into the nostrils. These are quite flexible and soft, and most patients tolerate them very well. However, you may need to breathe more through your mouth in the first few days after surgery, as there may be some bleeding and inflammation as the area heals.

Most patients are able to return to a lighter version of themselves within a few weeks after their Transsphenoidal Hypophysectomy. Based on your unique situation and medical history, Dr. Greenwald will give you specific aftercare instructions and may need to see you for a follow up appointment a few weeks after surgery.

Transsphenoidal Hypophysectomy Side Effects

As with any surgery, patients may experience side effects after Transsphenoidal Hypophysectomy. This can include sinus congestion while the wound heals, nose bleeding, and nausea. However, these should resolve within several weeks. If you do experience severe nose bleeding, it is important to let Dr. Greenwald know about the problem as soon as possible.

Additionally, a small percentage of patients may experience cerebrospinal fluid leakage. This can occur if the cartilage graft does not heal quickly enough or is displaced by strenuous physical activity before it heals. This issue can be repaired with a follow up procedure if necessary. However, this does not happen in the vast majority of cases. If you do experience discharge of a clear liquid from your nose, or taste a salty liquid in the back of your throat, please contact Dr. Greenwald’s office immediately to address the issue.

Your Transsphenoidal Hypophysectomy Consultation

Although a pituitary tumor diagnosis can be unsettling, Transsphenoidal Hypophysectomy is an effective procedure that has been used to successfully treat numerous patients around the world. Further, Dr. Greenwald is an expert neurosurgeon who takes great care during the procedure, and always takes the necessary time to ensure that each patient receives individualized attention. Patient safety and compassionate care are of paramount importance to Dr. Greenwald.

If you have been diagnosed with a pituitary gland tumor, or if you would like a second opinion, please schedule an appointment with Dr. Greenwald. You can schedule your Transsphenoidal Hypophysectomy consultation by calling our office at (650) 968-4747, or email us through the Contact Form and we will guide you every step of the way.

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