The pituitary gland is located in the lower front part of the brain and is a hormone-secreting gland that regulates the body’s hormonal systems. Tumors that develop in this gland can cause various signs and symptoms both by compressing surrounding tissues and through the hormones they secrete. Some of these findings include slowly developing visual field defects or rapidly progressive vision loss due to its close proximity to and pressure on the optic nerves.
Depending on the type of hormone secreted, many different manifestations may occur, such as enlargement of the hands, feet and face, menstrual irregularities, milk production or discharge from the breasts, infertility, impotence, weight gain or weight loss.
Because of the problems it causes and its location, the management of this disease involves many medical specialties. Visual problems concern ophthalmologists, hormonal problems are managed by endocrinologists, and the surgery itself is performed by neurosurgeons and ear, nose and throat (ENT) surgeons.
The pituitary gland forms a projection into a sinus called the sphenoid sinus, which lies behind the nasal cavity. Therefore, reaching these masses through the nasal cavity rather than through the brain itself minimizes damage to surrounding tissues and allows a faster recovery after surgery.
Accessing this region through the nose enables ENT surgeons and neurosurgeons to work together, which makes it possible to perform the operation with less tissue damage and fewer complications.
In this approach, the traditional method has been microscopic surgery; however, especially in recent years, endoscopes that transmit light and images have also come into use and have gained an increasingly wide field of application both in our country and worldwide.
With the endoscopic approach, intranasal structures (such as the nasal septal cartilage) are preserved, as the surgeon enters directly through the natural opening where the sinus drains into the nose. In this way, postoperative nasal packing is generally not required.
The angled view provided by the endoscope makes it easier to identify any residual tumor tissue, allowing removal of tumor fragments that might otherwise remain hidden.
Although pituitary surgery is a highly safe procedure, the close neighborhood of critical structures can lead to certain problems during the operation. Some of these complications are relatively minor, such as nasal obstruction and loss of sense of smell, whereas more serious problems may include cerebrospinal fluid (CSF) leaks, seen in about 1–5% of cases, and very rare injuries to the optic nerve or the carotid artery, reported in roughly 1 in 1,000 to 1 in 10,000 cases. To minimize these risks, it is essential to perform detailed preoperative radiological evaluations, to use computer-assisted navigation systems during surgery when necessary, and to have the procedure carried out by experienced surgeons.
In conclusion, endoscopic surgery of the pituitary gland helps achieve a more complete removal of the tumor and contributes to minimizing possible complications, particularly those related to the nose.