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Pituitary Adenoma Surgery Endonasal Endoscopic Approach Tips

Pituitary Surgery: What You Need To Know?

Dr. B G Ratnam 88% (10 ratings)
MBBS , MCh (Neursurgery), MCh
Neurosurgeon, Hyderabad
Pituitary Surgery: What You Need To Know?

Endocrine complications

DI and anterior pituitary insufficiency were the most frequent complications reported in the national survey. With the least experienced surgeons, one of five transsphenoidal operations resulted in both of these complications. In contrast, the incidence of these complications was lower in the hands of the most experienced surgeons.

Figure 11Postoperative anterior pituitary insufficiency has been reported in the literature as being rare (72). Various series cite an incidence ranging from less than 1 to 10% (63, 97,101), with one series reporting an incidence of 27% (82). Postoperative anterior pituitary insufficiency was also reported to occur more frequently after removal of larger tumors and in patients whose anterior pituitary functions were impaired pre-operatively (63).The residual normal anterior pituitary tissue can be identified in the preoperative, T1-weighted, infused magnetic resonance imaging scans as a thin layer of enhanced tissue draping around the tumor,mostly over the upper pole of the tumor (Fig. 11). Every effort should be made to preserve this attenuated, residual, normal anterior pituitary tissue, because it can prove sufficient to maintain or even improve anterior pituitary functions in the postoperative period (64).

Temporary post-transsphenoidal surgery DI has been reported to occur in 10 to 60% of cases (26, 68, 82). Permanent DI, however,seems to be relatively rare, with the reported incidence ranging in most large series from 0.5 to 15% (8, 26, 44, 52, 61, 68, 71,97,101). DI after removal of microadenomas usually occurs as a consequence of stalk manipulations. Vertically oriented vessels on the pale-reddish stalk are helpful landmarks for recognizing the stalk. In pituitary macroadenomas, the stalk and the posterior lobe are often not seen because they can be displaced in any direction, flattened, and covered by a fibrous layer. The latter finding explains the relatively low incidence of permanent postoperative DI in patients undergoing removal of pituitary macroadenomas.

In addition, the postoperative course can be complicated by inappropriate secretion of the antidiuretic hormone, which occurs usually on the 6th or 7th postoperative day and thus frequently after the patient has been released from the hospital (5,15,19,95, 97). One of the explanations for this phenomenon is presumed necrosis of a portion of the posterior lobe because of surgical trauma, resulting in a sudden release of the antidiuretic hormone.

5 people found this helpful

How To Spot The Signs of Pituitary Glands?

Dr. Namit Singhal 90% (26 ratings)
MCH Neuro Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery, MS - General Surgery
Neurosurgeon, Agra
How To Spot The Signs of Pituitary Glands?

Pituitary tumors are a rare occurrence, and not all of them show some kind of symptoms. However, in some cases, the patients may display few symptoms. This totally depends on whether the tumor is functional or non-functional. When the tumor is functional, it means that they are releasing excess hormones while non-functional tumor would not cause excess release of hormones.

Types of pituitary tumors:
As already pointed, there are two variants of pituitary tumors- functional and non-functional.

  • Functional adenomas can lead to issues owing to the hormones they release. Typically, a functional adenoma creates an excess amount of a single hormone. The symptoms are dependent on the type of hormone secreted by them.
  • Tumors which do not lead to excess secretion of hormones tend to become large even before they are noticed. They may lead to different kinds of symptoms when they press against other parts of the brain or nerves or other areas of the pituitary.
  • Non-functional adenomas which do not lead to any symptoms are often found owing to the MRI or CT scan performed for other health troubles. These tumors are becoming more common since CT scans and MRIs are done more commonly, and these are the most prevalent type of tumors. There is no need to treat them as long as they do not cause any discomfort or symptoms.

Symptoms caused by pituitary tumors:
The carcinomas, as well as macroadenomas, are large enough to press on a nearby nerve or other parts of the brain regardless of whether they are functional or not. This may lead to signs and symptoms such as loss of peripheral vision, headaches, dizziness, facial numbness or pain, blurred or double vision and loss of consciousness. Sudden bleeding into the tumor can lead to loss of consciousness and even death. Depending on the type of nerves affected by the pituitary tumor can cause weakness, unexplained loss or gain of weight, nausea, feeling tired and cold, menstrual changes, erectile dysfunction, and reduced interest in sex, particularly in men.

Treatment of pituitary tumors:
Many patients suffering from pituitary tumors do not need any treatment. However, there are various factors like the size, type, and reach of the tumor that play an important role in deciding whether the patients require treatment or not. Moreover, the age of the patients and overall health conditions are the most crucial aspect in the decision of the same.

Surgical removal of the pituitary tumor is generally advised by the doctor when the tumor is pressing on the optic nerves or when the tumor is overproducing some hormones. On the other hand, radiation therapy makes use of high-energy X-rays for destroying tumors. Lastly, treatment with medicines can help in blocking excess secretion of hormone and even shrink certain types of pituitary tumors.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1982 people found this helpful

Endoscopic Skull Base Surgery - Things You Must Know About It!

Dr. Anjan Jyoti Bhuyan 93% (108 ratings)
MS - ENT
ENT Specialist, Guwahati
Endoscopic Skull Base Surgery - Things You Must Know About It!

There are a number of parts in the human body, which cannot be easily accessed. In times of disease or other complications, it becomes difficult for doctors and other medical practitioners to access those areas of the body in order to facilitate proper treatment. This not only leads to aggravation of the disease and further complications, but also prolongs the agony. However, technological advancements have made it possible for surgeries and other medical interventions to become easier.

Surgery for the skull base using endoscopy has become the chosen path these days. The reasons for these are as follows:

  1. The intrusion is minimum.
  2. There are no ugly scars or stitch marks.
  3. The patient feels the least amount of pain as compared to any other method of operation.
  4. It is likely to be far more effective.

The people who choose to go for this sort of an operation are most likely to be suffering with problems with regard to:

  1. Skull
  2. Spinal cord

Since bones and cartilages makeup a major part of the skull structure, the medical practitioner who will be entrusted with the job of taking care of the complexity should be well-versed with the history or cause of the development of the following:

  1. Cysts that have developed over the years
  2. Problems which a person may be born with
  3. Cancerous swellings which may aggravate as the years go by
  4. Tumours which may not be that harmful as long as they are taken care of swiftly
  5. Fluid leaks which may make their way to other parts of the body

Different skull bade surgeries are done through nasal endoscope by an ENT surgeon. For example pituitary tumor surgery, repair of brain fluid leakage surgery, etc.‚Äč Usually, below given are two types of endoscopic skull base surgery, which may be required for a person:

  1. The minimally invasive type, which does not cause much of an opening
  2. Open surgery where an incision has to be made in the facial area or somewhere in the vicinity of the complication

Nonetheless, both these measures are equally beneficial and effective as far as outcomes are concerned. Patients who come up with such complaints usually have symptoms like inability to hear properly, numbness, headache and dizziness, and facial pain. These are some of the preliminary signs when a person should get a check up immediately. Also, chemotherapy and radiation therapy can be considered to be some of the options that can be used in conjunction with the endoscopy method of skull base surgery. That way, the chances of a positive outcome will be higher. If you wish to discuss about any specific problem, you can ask a free question.

2809 people found this helpful

Carpal Tunnel - How Endoscopic Surgery is Beneficial?

Dr. Prathmesh Jain 86% (68 ratings)
M.S. Orthopedics, MBBS
Orthopedist, Ahmedabad
Carpal Tunnel - How Endoscopic Surgery is Beneficial?

The carpal tunnel is the passageway for the median nerve to pass through on the inner side of your hand, when your palms are facing down. For example, while typing, there is a lot of movement of the fingers and this puts a lot of pressure on this tunnel. In fact, people who are involved in a lot of typing are one of the most prone people for carpal tunnel syndrome (CTS). Other causes would include trauma, fractures, etc., where the tunnel is injured.

Conventional measures to treat CTS included a combination of exercise and pain killers in mild to moderate cases. In moderate (sometimes) to severe cases, surgery was also done. However, with advancements in medical technology, endoscopic surgical procedure is gaining popularity.

What is done?
In endoscopic surgery, a small incision is made in the wrist or one each in the palm and the wrist. Through this, a flexible tube with a camera and minute cutting tools are inserted into the wrist. Another ligament known as transverse carpal ligament is cut. This reduces the pressure on the median nerve, which provides relief from the CTS symptoms.

What to expect as benefits?
The intention behind the surgery remains the same in both traditional and endoscopic procedures. The pressure on the median nerve is released, restoring movement and reducing pain in the joints. In addition, the endoscopic procedure has the following benefits.

  1. Less invasive: Needless to say, there are only one or two small incisions done for this procedure, so less surrounding tissue is damaged.
  2. Same day surgery: No hospitalization is required, and unless required, the patient can return home on the same day of surgery.
  3. Reduced recovery time: The recovery period is usually substantially less compared to the traditional surgical approach.
  4. Back to work: Depending on which is your dominant hand, you would be able to return to your regular work earlier than with regular surgery. If your non-dominant hand is involved, a day or two of rest is required. If your dominant hand was involved, give it up to four weeks for complete recovery.
  5. Reduced chances of nerve injury: The area of operation has many nerves and blood vessels, and endoscopic surgery reduces the chances of damaging adjacent nerves.
  6. Anesthesia: This is done under local anesthesia. Therefore, complications arising out of general anesthesia are completely avoided.

Indications
While these sound promising, your doctor will decide if you are a candidate for endoscopic procedure depending on the following:

  • Nonsurgical treatment including exercise and pain killers have not provided relief, even after several months.
  • Severe symptoms including those of nerve damage, like loss of sensation, altered coordination, etc., is affecting your normal daily routine.
  • Person requiring bilateral surgery like severe trauma, wheelchair dependent, etc.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2596 people found this helpful

Common FAQs About Endoscopic Surgery!

Dr. Praveen C R 90% (10 ratings)
MBBS, MS - General Surgery, Diploma In Minimal Access Surgery
General Surgeon, Bangalore
Common FAQs About Endoscopic Surgery!

Nowadays, people do not have to go for open surgeries for the treatment of certain conditions. You need not have large incisions on your body for getting a surgery done. It can be done with a few small incisions. This kind of surgery has a lot benefits over the open surgery such as less pain, less recovery time, fewer scars and less time in the hospital. So, with so many benefits, who would choose an open surgery? For those who are opting for an endoscopic surgery for any problem and have no knowledge about it, here are some common FAQs about endoscopic surgery.

What is endoscopic surgery?
Endoscopy means inserting a small tube into the body, to inspect the interior. A small endoscope is inserted, which has a camera and light attached to it. This will help in seeing the internal organs of the body without having to cut open the body. Usually, this procedure is used for diagnosing certain health conditions. But in some conditions, it is also used for providing treatment.

Is there anything I should know before the endoscopic surgery?
Yes, your doctor will help you understand what to eat and what not to eat, also he will tell you about when to stop eating. Your body has to be prepared for the endoscopy.

Are there any kind of side effects of endoscopic surgery?
Any kind of surgery will have some pain. It is the same with endoscopy as well. With endoscopic surgery, the pain is less but there is no surgery with zero pain. Hence, you will have some pain at the place of the surgery. This depends on the place of surgery and how far the incisions are made.

Are there any chances of moving to an open surgery during the endoscopic surgery?
This happens in very rare conditions that you need to switch to an open surgery. You need to discuss this with your doctor in advance in order to understand whether it can happen. Not all surgery will require this.

How long does it take for recovery?
Usually, endoscopic surgeries are performed even on an outpatient basis. That means you need not even have to get admitted to the hospital for getting the surgery done. You can take care of yourself at home and keep visiting the doctor as suggested.

What kind of medicine is usually prescribed?
Depending on the type of surgery that you have undergone, you will be prescribed medicine. Along with that, you will also be prescribed painkillers after any kind of surgery. The pain is usually less but taking one or two pills may be required.  In case you have a concern or query you can always consult an expert & get answers to your questions!

1901 people found this helpful

Pituitary Gland Tumor - How To Spot The Signs of It?

MCh - Neurosurgery, MBBS
Neurosurgeon, Chennai
Pituitary Gland Tumor - How To Spot The Signs of It?

Pituitary tumors are a rare occurrence, and not all of them show some kind of symptoms. However, in some cases, the patients may display few symptoms. This totally depends on whether the tumor is functional or non-functional. When the tumor is functional, it means that they are releasing excess hormones while non-functional tumor would not cause excess release of hormones.

Types of pituitary tumors:
As already pointed, there are two variants of pituitary tumors- functional and non-functional.

  • Functional adenomas can lead to issues owing to the hormones they release. Typically, a functional adenoma creates an excess amount of a single hormone. The symptoms are dependent on the type of hormone secreted by them.
  • Tumors which do not lead to excess secretion of hormones tend to become large even before they are noticed. They may lead to different kinds of symptoms when they press against other parts of the brain or nerves or other areas of the pituitary.
  • Non-functional adenomas which do not lead to any symptoms are often found owing to the MRI or CT scan performed for other health troubles. These tumors are becoming more common since CT scans and MRIs are done more commonly, and these are the most prevalent type of tumors. There is no need to treat them as long as they do not cause any discomfort or symptoms.

Symptoms caused by pituitary tumors:
The carcinomas, as well as macroadenomas, are large enough to press on a nearby nerve or other parts of the brain regardless of whether they are functional or not. This may lead to signs and symptoms such as loss of peripheral vision, headaches, dizziness, facial numbness or pain, blurred or double vision and loss of consciousness. Sudden bleeding into the tumor can lead to loss of consciousness and even death. Depending on the type of nerves affected by the pituitary tumor can cause weakness, unexplained loss or gain of weight, nausea, feeling tired and cold, menstrual changes, erectile dysfunction, and reduced interest in sex, particularly in men.

Treatment of pituitary tumors:
Many patients suffering from pituitary tumors do not need any treatment. However, there are various factors like the size, type, and reach of the tumor that play an important role in deciding whether the patients require treatment or not. Moreover, the age of the patients and overall health conditions are the most crucial aspect in the decision of the same.

Surgical removal of the pituitary tumor is generally advised by the doctor when the tumor is pressing on the optic nerves or when the tumor is overproducing some hormones. On the other hand, radiation therapy makes use of high-energy X-rays for destroying tumors. Lastly, treatment with medicines can help in blocking excess secretion of hormone and even shrink certain types of pituitary tumors.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3621 people found this helpful

Endoscopic Vein Harvesting for Bypass Surgery!

M.Ch Cadiac Surgery, M.S
Cardiothoracic Vascular Surgery, Mohali
Endoscopic Vein Harvesting for Bypass Surgery!

Sarwalheartsurgery at max institute of ctvs, max superspeciality hospital, mohali has launched endoscopic vein harvesting (taking out veins through key hole) on a regular basis for bypass surgery. We are the pioneers in this region north of delhi with no other hospital offering this so far on routine basis the procedure is of immense benefit. No long incisions on leg, low or no infection rates and no uneasiness, less swelling of legs at a very economical cost extra to the package. It has huge benefit in females cosmetically and no infections especially in obese and diabetic patients.

2 people found this helpful

6 Reasons You Should Approach A Physiotherapist After Hip Replacement Surgery!

Dr. Amin A. Khan 90% (271 ratings)
MDT(Mc Kenzie) , P.G-Dietitian, N.D.T-( Neuro Development Technic ), Physiotherapist
Physiotherapist, Mumbai
6 Reasons You Should Approach A Physiotherapist After Hip Replacement Surgery!

Physiotherapy plays a pivotal role in helping a person recover after a hip replacement surgery. It brings back the old flexibility and prevents blood clots in the area where the procedure has taken place. After the surgery team gives its green signal, a physiotherapist starts working with a patient for a full recovery.

Here is a list of some common exercises that a physiotherapist suggests after a hip replacement surgery:

  1. Walking: It is important to use the crutches for a time period of 4-5 weeks post the procedure. Until the surgeon or the physiotherapist advises against using the crutches, it makes sense to use it while walking. It makes sense to retain the normal walking posture by using the crutches rather than limping without it. A physiotherapist reviews the pressure exerted by the arm while holding a crutch, before advising the patient to get rid of the crutches.
  2. Increasing hip flexibility: This is a basic form of exercise where an individual lies on one side of the body with knees and hips bent. A pillow is placed in between the knees. While doing this, it should be ensured that both the feet is kept together and the back muscle is not twisted. The top knee should be slowly raised like an opening of the calm shell. This position should be maintained for 4-5 seconds.
  3. Strengthening the hips: The body should rest on the stomach. The buttocks should be tightened and one leg should be slowly lifted. This position should be maintained for a stretch of 3-5 seconds. The same should be repeated for both the legs.
  4. Strengthening the hip and the stomach muscle: The body should rest on the back with a leg bent. The stomach muscle should be tightened and the bent leg should be lifted carefully while ensuring that the bend does not supersede more than 90 degrees. While keeping the stomach muscle tight, the lifted leg should slowly come down to touch the surface. This act should be repeated for 5-6 times.
  5. Strengthening the thigh muscle: While sitting in a steady chair, an elastic loop should be wrapped around the ankles. The elastic loop should be stretched with one leg while keeping the other foot firmly rooted to the ground. The lifted foot should slowly come down to the normal position. The same act should be repeated for 4-5 times.
  6. Improving balance: An elastic loop should be tied to one leg of a table and the other end of the loop should be tied to one ankle. The table should be held on for maintaining balance. Maintaining an erect position, the tied up ankle should be stretched sideways. The position should be maintained for 3-5 seconds to return back to normal standing position. In case you have a concern or query you can always consult an expert & get answers to your questions!
4766 people found this helpful

Causes and Symptoms of Bronchial Adenoma

Dr. Mool Chand Gupta 91% (35709 ratings)
MD - Pulmonary, DTCD
Pulmonologist, Faridabad
Causes and Symptoms of Bronchial Adenoma

Bronchial adenoma is an uncommon benign tumour that begins in the mucous glands and the airways of the lungs (bronchi). These cancers progress very slowly and can be cured if detected. These cancers can easily spread to other parts of the body, such as the adjoining cells and tissues. These types of cancers, however, respond well to treatment.

There are three types of bronchial adenoma:

  1. Adenoid cystic carcinoma: This type of cancer starts in the salivary glands of the mouth; it may also affect the sweat glands, trachea (windpipe) and the woman's breasts.
  2. Carcinoid tumors: These tumors impair the functioning of the nerve cells and cells that produce hormones. They usually develop in the stomach and the lungs.
  3. Mucoepidermoid carcinoma: This type develops in the salivary glands. The parotid glands near the ears are usually affected.

Causes: The exact cause of this disorder is not known. It is believed that some genes in the body are responsible for mutation of the cells. Multiple endocrine neoplasia (a combination of diseases which affects the endocrine system of the body) increases the risks of being affected by bronchial adenoma.

Symptoms: Since these tumors progress very slowly, initially the symptoms might not be apparent. In the latter stages, the symptoms that show up depend on the location of the cancer.

For carcinoid tumors, the symptoms are:

  1. You may experience wheezing and cough
  2. Presence of blood in the cough
  3. Chest pain and breathing difficulties
  4. Becoming increasingly susceptible to infections such as pneumonia

For mucoepidermoid carcinoma, the symptoms are:

  1. The glands near the ears may swell
  2. You may experience pain in your face

For Adenoid cystic carcinoma, the symptoms are:

  1. Trouble while swallowing food
  2. Hoarse voice
  3. Swelling on the roof of your mouth
  4. Numbness in the jaw
  5. Bumps below the jaw
4423 people found this helpful

Bronchial Adenoma: Types and Symptoms

Dr. Anand N Yannawar 86% (10 ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery, Diploma In HIV, DNB - Respiratory Diseases, V P Chest Delhi
Pulmonologist, Pune
Bronchial Adenoma: Types and Symptoms

Bronchial adenoma is an uncommon benign tumour that begins in the mucous glands and the airways of the lungs (bronchi). These cancers progress very slowly and can be cured if detected. These cancers can easily spread to other parts of the body, such as the adjoining cells and tissues. These types of cancers, however, respond well to treatment.

There are three types of bronchial adenoma:

  1. Adenoid cystic carcinoma: This type of cancer starts in the salivary glands of the mouth; it may also affect the sweat glands, trachea (windpipe) and the woman's breasts.
  2. Carcinoid tumors: These tumors impair the functioning of the nerve cells and cells that produce hormones. They usually develop in the stomach and the lungs.
  3. Mucoepidermoid carcinoma: This type develops in the salivary glands. The parotid glands near the ears are usually affected.

Causes: The exact cause of this disorder is not known. It is believed that some genes in the body are responsible for mutation of the cells. Multiple endocrine neoplasia (a combination of diseases which affects the endocrine system of the body) increases the risks of being affected by bronchial adenoma.

Symptoms: Since these tumors progress very slowly, initially the symptoms might not be apparent. In the latter stages, the symptoms that show up depend on the location of the cancer.

For carcinoid tumors, the symptoms are:

  1. You may experience wheezing and cough
  2. Presence of blood in the cough
  3. Chest pain and breathing difficulties
  4. Becoming increasingly susceptible to infections such as pneumonia

For mucoepidermoid carcinoma, the symptoms are:

  1. The glands near the ears may swell
  2. You may experience pain in your face

For Adenoid cystic carcinoma, the symptoms are:

  1. Trouble while swallowing food
  2. Hoarse voice
  3. Swelling on the roof of your mouth
  4. Numbness in the jaw
  5. Bumps below the jaw
1083 people found this helpful
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