Our Summary

This paper looks at the frequency and types of pituitary surgeries performed in Japan between 2010 and 2016, using a nationwide database. The pituitary is a small organ in the brain that produces hormones. Sometimes, problems like tumors can affect it and surgery may be necessary.

Two main types of surgery are used: microscopic transsphenoidal surgery (mTSS) and endoscopic TSS (eTSS). Both methods approach the pituitary gland through the nose and sinus cavity, but use different tools. Microscopic surgery uses a microscope to see the area, while endoscopic surgery uses a small camera.

In the study, they found that 88% of patients underwent TSS surgery, with 77% of those being endoscopic and 23% microscopic. They also found that the number of patients having TSS, particularly endoscopic, increased each year. Furthermore, hospitals that performed more of these surgeries were more likely to choose endoscopic over microscopic.

Interestingly, they found that patients who had endoscopic surgery were less likely to develop a condition called hyponatremia (low sodium levels in the blood) compared to those who had microscopic surgery. There was no difference in the likelihood of other major complications between the two types.

The most common reason for surgery was non-functioning pituitary adenomas, a type of benign tumor.

In conclusion, the use of TSS, particularly endoscopic, is increasing for pituitary surgeries, and may have some benefits over microscopic surgery. This study provides useful information for future research into pituitary surgery trends and outcomes.

FAQs

  1. What are the two main types of pituitary surgeries performed and how do they differ?
  2. What was the most common reason for pituitary surgery according to the study?
  3. What benefits does endoscopic surgery have over microscopic surgery, according to the findings of this study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully, such as fasting before surgery and avoiding certain medications. It is also important to discuss any concerns or questions with your healthcare team before the procedure. Additionally, post-operative care and follow-up appointments are crucial for monitoring recovery and ensuring the best possible outcome.

Suitable For

Patients who are typically recommended brain surgery include those with pituitary tumors, especially non-functioning pituitary adenomas. These tumors can cause hormonal imbalances and other symptoms that may require surgical intervention. Other conditions that may warrant brain surgery include tumors in other parts of the brain, traumatic brain injuries, aneurysms, and certain neurological conditions such as epilepsy or Parkinson’s disease. Ultimately, the decision to recommend brain surgery is based on the individual patient’s specific condition and needs, and should be made in consultation with a neurosurgeon or other healthcare provider.

Timeline

Before brain surgery, a patient typically undergoes a series of tests and consultations with their medical team to determine the need for surgery and the best approach. This may include imaging scans, blood tests, and discussions about the risks and benefits of the procedure. The patient may also need to make preparations for their recovery, such as arranging for time off work and support at home.

During the surgery, the patient is under general anesthesia and the surgical team accesses the pituitary gland through the nose and sinus cavity. The type of surgery, either microscopic or endoscopic, is chosen based on the specific case and the preferences of the surgical team. The surgery typically lasts several hours, and the patient may need to stay in the hospital for a few days for monitoring and recovery.

After the surgery, the patient may experience some pain and discomfort, as well as potential side effects like nasal congestion or changes in hormone levels. They will need to follow up with their medical team for monitoring and may need to take medication to manage hormone imbalances or other issues. Recovery time varies depending on the individual and the specifics of the surgery, but most patients are able to resume normal activities within a few weeks to months. Long-term follow-up may be needed to monitor for any recurrence of tumors or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about brain surgery for pituitary tumors include:

  1. What type of surgery do you recommend for my specific case: microscopic transsphenoidal surgery (mTSS) or endoscopic TSS (eTSS)?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of the surgery for treating pituitary tumors?
  4. How long is the recovery period after the surgery?
  5. Will I need hormone replacement therapy after the surgery?
  6. How often do you perform pituitary surgeries and what is your experience with both types of surgery?
  7. Are there any alternative treatment options for my pituitary tumor?
  8. What are the chances of the tumor recurring after the surgery?
  9. Will I need follow-up imaging or blood tests to monitor the tumor after the surgery?
  10. What can I do to prepare for the surgery and optimize my recovery process?

Reference

Authors: Hattori Y, Tahara S, Aso S, Matsui H, Fushimi K, Yasunaga H, Morita A. Journal: Acta Neurochir (Wien). 2020 Jun;162(6):1317-1323. doi: 10.1007/s00701-020-04270-4. Epub 2020 Mar 3. PMID: 32125502