Pituitary tumours have an estimated prevalence of somewhere between 15-22.5%, with clinically relevant pituitary adenomas occurring in 1/1000 individuals worldwide.
The clinical manifestations of pituitary adenomas are extremely broad, with emerging data clearly defining the impact of hormonal and neurological sequelae of many tumours impacting quality of life and life expectancy.
Although many pituitary tumours do not need treatment there are others that require surgical removal. This is usually because they are growing and are causing compression of some important structures, or in other cases where the hormones being secreted can have significant medical and physiological effects.
Endoscopic pituitary surgery, also called transsphenoidal endoscopic surgery, is the most common surgery used to remove pituitary tumors. The pituitary gland is located at the bottom of your brain and above the inside of your nose. It is responsible for regulating most of your body’s hormones.
Endoscopic pituitary surgery is done with an endoscope. An endoscope is a thin, rigid tube that has a microscope, light, and camera built into it, and it’s usually inserted through the nose. The camera allows us to watch a magnified version of your tumour whilst we resect it from the surrounding structures.
St Vincent’s Hospital was the first Hospital in Australia to perform the removal of a pituitary tumour. This was performed by Sir Victor Horsely in 1952. Since that time St Vincent’s has been at the forefront of skull base surgery, where we are now striving to be a Centre of Excellence for Pituitary Tumour Management. We perform more pituitary surgeries than any other Hospital in NSW and have a dedicated team managing pituitary disorders.
Management and removal of pituitary tumours requires a dedicated Endoscopic Skull Base Team. The team includes Neurosurgery, ENT, Endocrinologists, Neuroradiologists, Neuro-ophthalmologists, Experienced Nursing Staff (Thetares and Wards) and Neuro-oncologists. We are fortunate to have a World class team at St Vincent’s Hospital which includes:
A/Prof Winder undertook a dedicated Skull Base and Pituitary Fellowship in Seattle, Washington. He was fortunate enough to be able to work alongside some World Experts in the field, operating on over 15-20 pituitary tumours per week. He has completed the world renowned Pittsburgh Endoscopic Skull Base Course, enabling a minimally invasive approach to complex skull base lesions such as pituitary tumours. Since returning to Australia in 2010, A/Prof Winder has been actively involved in helping further the skull base team at St Vincent’s Hospital. The Pituitary Service now offered at St Vincent’s offers a dedicated Pituitary Team, that encompasses diagnosis, management and research through a Multidiciplinary team. The service is aimed at the Centre of Excellence for the management of Pituitary Services and has been able to institute the Sydney Collaborative Pituitary Meetings.
ENT (Ear, Nose and Throat Surgeons). The ENT surgeon performs the approach to the pituitary gland with the use of the endoscope. We are fortunate to have a World recognized neuro-rhinologist, Associate Professor Richard Harvey, who is an expert in the field. We have been working together as a team for over 7 years, attaining the highest possible clinical results.
The specialists of hormonal management are the principal managers of hormone regulation. They are intricately involved in diagnosis, peri-operative management and subsequent post operative management of pituitary tumour patients. We are extremely lucky to have experts in the field and include:
Dr Anne McCormack
Assoc Profesor Jerry Greenfield
Dr Andrew Weissberger
Dr Kathy Samaras
Dr Daniel Chen
These members of the team are an essential part of the management and assessment when treating pituitary tumours. All members are part of the Multi-disciplinary team and are integrally involved in the overall management of any of our patients treated for a pituitary tumour.
Endoscopic pituitary surgery is done to remove certain types of tumors that start to grow in your pituitary gland:
Endoscopic pituitary surgery is a VERY safe type of surgery, but all surgical procedures carry some risk for reaction to anesthesia, bleeding, and infection. Risks and complications that may occur with this type of surgery also include:
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with Dr Winder before the procedure.
You will likely have seen and endocrinology specialist for an evaluation before surgery. Endocrinologists are the medical specialists that deal with glands and hormones. You may also have your vision checked before surgery.
Endoscopic pituitary surgery is usually done under general anesthesia, so you will be asked to stop eating and drinking after midnight on the night before surgery. You may need to stop taking some types of medications that may increase bleeding during surgery. Don’t take any over-the-counter medications before surgery without telling your doctor. You may have several blood tests, an ECG, and a chest X-ray. These will all be checked before surgery and you will need to be examined by the doctor who gives anesthesia.
You will be asked to have an MRI or CT prior to surgery so that we can perform stereotactic navigation at the time of surgery. This enables us to be very accurate with the exposure, aimed at minimizing any complications.
The actual surgery may take a few hours.
Dr Harvey will place the endoscope through the nose. A mucosal flap is usually raised which will be placed over the site of tumour removal at completion
You may need to stay in the hospital for several days. During this time, nurses will help you with any dressings and bathroom needs. A catheter is in place and will normally be removed at Day 2. You will be able to return to a normal diet as long as you are taking fluids well. You will be encouraged to get out of bed and walk as soon as you are able. While in the hospital, you will be asked to help your nurses keep track of the amount of fluids you drink and your urine output to evaluate pituitary function.
You will be on intra-venous antibiotics whilst in hospital and will be on an oral course of antibiotics for a period of 2 weeks in total
Aftercare at home may include:
It is important to let your surgeons know about:
