Conditions Treated

Pituitary adenoma

A common tumour involving the pituitary gland. It can grow big (macroadenoma) and can cause visual deterioration. A hormone secreting tumour can cause Acromegaly, Cushing’s syndrome, or Prolactinoma. A pituitary Apoplexy (bleed into the tumour) can compress the nerves of the eye and cause double vision along with headache and is a surgical emergency. Here we approach this through the nose, via sphenoid sinus to excise the tumour. To prevent CSF leak sometimes a nasal mucosal flap is harvested. It will be rotated to cover the defect in the operative area.

Craniopharyngioma

It is a childhood (and sometimes adult-onset) tumour of the skull base which can cause growth retardation with pituitary gland dysfunction. Sometimes these tumours need endoscopic approach for removal and radiation therapy for the residual tumour.

Meningioma

Skull base meningiomas of anterior skull base is operated through endoscopic transnasal approach occasionally.

Clival chordoma

They are rare tumours arising from the dura of the skull base near clivus which needs Extended endoscopic transnasal surgery for excision. The

Rathke’s cleft cyst

They are rare anomalies of the pituitary fossa which needs surgery occasionally.

Petrous apex lesions (Schwannoma, Cholesteatoma)

These are rare lesions approached through the extended endoscopic transpterygoid approach.

CSF Rhinorrhoea

Sometimes brain fluid (cerebrospinal fluid-CSF) leaks through the nose via defect in the anterior or middle cranial fossa base. These leaks need repair as it can lead to intracranial infection (Meningitis). This repair is done through an endoscopic endonasal approach. In these surgeries we sometimes insert a lumbar drain and instil fluorescein dye through the drain, to delineate the defect better and perform a successful repair. Here we take fascia, fat and muscle tissue from the thigh and use medical grade glue to cover the defect.

TONES

Transorbital neuro-endoscopic surgery aims at treating medial temporal and cavernous sinus lesions (located in skull base) via a small hole in the socket of the eye. (minimally invasive approach). It is an exciting new field within the endoscopic skull base surgery.

Technology used in Pituitary tumour surgery

• High-definition Endoscopes
• Neuronavigation
• Intracranial Doppler
• Intra-operative MRI
• CUSA