Endoscopic pituitary surgery in Jordan
(عملية أورام الغدة النخامية بالمنظار (عبر الأنف
Endoscopic transnasal (transsphenoidal) pituitary surgery removes a tumour of the pituitary gland or of the region immediately around it through the natural corridor of the nose and the sphenoid sinus. A slim endoscope and fine instruments are used, so there is no craniotomy and no visible incision on the face or the scalp. Surgery is usually considered when the tumour presses on the optic pathways and narrows the visual field, when it secretes hormones that disturb the whole body such as excess growth hormone or excess cortisol, when repeated imaging shows the lesion enlarging, or when there is sudden bleeding inside the tumour causing severe headache and rapid visual loss, which is treated as an emergency. The decision is never taken by one doctor alone. A multidisciplinary team of neurosurgeon, endocrinologist, ENT surgeon, ophthalmologist and neuroradiologist reviews dedicated pituitary MRI, hormone profiles and formal visual field testing. Whether a particular person is a candidate is determined by clinical examination and by these results, not by reading a web page. The limits of the operation matter as much as its aims. It does not necessarily restore vision that has been compressed for a long time, and it does not guarantee that hormone secretion returns to normal; some patients need hormone replacement for a long period. Removal is not always complete, particularly when the tumour extends into the cavernous sinus or wraps around arteries, so the plan may be completed with surveillance or with targeted radiotherapy. Prolactin-secreting tumours are usually treated with medication first rather than surgery, and the operation does not correct hormonal disorders whose cause lies outside the pituitary gland. The procedure is performed under general anaesthesia and normally needs a short inpatient stay with close monitoring of consciousness, vision and fluid and salt balance, followed by hormonal review, repeat visual field testing and comparison imaging at intervals set by the treating team.
Procedure steps
- 1
Assessment and multidisciplinary planning
Pituitary-protocol MRI, hormone results and visual field testing are reviewed, the nose and sinuses are assessed to choose the safest corridor, and the team agrees on a clear goal: complete removal, or decompression with a planned second stage of surveillance or radiotherapy.
- 2
Anaesthesia and preparation of the nasal corridor
General anaesthesia is given, the inside of the nose is gently prepared to widen the route between the septum and the turbinates without removing more tissue than necessary, and image-guided navigation is registered so the position of every instrument is displayed against the patient's own scans.
- 3
Reaching the skull base through the sphenoid sinus
The sphenoid sinus is opened and the bony wall of the pituitary fossa exposed. Before any opening is made, the carotid arteries and optic nerves on both sides are identified using navigation and fixed anatomical landmarks, because protecting these structures matters more than speed of access.
- 4
Endoscopic tumour removal
The overlying membrane is opened and tumour tissue is removed step by step with fine instruments and gentle suction, taking care to distinguish tumour from healthy gland so that remaining pituitary function is preserved. Samples are sent to the laboratory to define the tumour type and its characteristics.
- 5
Skull-base reconstruction and monitored recovery
The opening is closed in layers of tissue to reduce the risk of a cerebrospinal fluid leak, nasal packing may be used for a short period, and the patient is then monitored for consciousness, vision, urine output and blood sodium before discharge.
Before the procedure
Tell your doctor about every medicine you take, especially blood thinners and anticoagulants, diabetes medicines and any hormone replacement, and never stop anything on your own; follow the treating team's instructions. Report drug allergies, sleep apnoea, and any previous nasal surgery or fracture. Complete your hormone tests, MRI and visual field assessment on the dates given, as these form the basis of the surgical plan. Treat any nasal, sinus or dental infection before the date and tell the team about it at once. Stop smoking as far as you can, and follow the fasting time set by the anaesthetist. Arrange someone to accompany you, bring your medicine list and previous reports, and ask in advance about steroid cover if you already take hormone replacement.
After the procedure
Do not blow your nose or block it, sneeze with your mouth open, and avoid straining, bending and lifting during the first weeks. Sleep with your head slightly raised, use no nasal spray or rinse unless prescribed, and ask your surgeon when air travel, diving and sport are allowed. Drink according to thirst, record your urine output if asked, and keep every appointment for hormone and sodium tests and for eye review. **Seek emergency care immediately** if clear watery fluid drips freely from your nose or you notice a salty taste with headache that worsens on standing; if you develop **fever with neck stiffness, severe headache and dislike of light**; if you have **intense thirst with large volumes of very pale urine**; if about a week after surgery you develop **nausea and vomiting with confusion or unusual drowsiness**; if your vision worsens or doubles; if you have heavy nosebleeding that will not stop; or if you feel profound weakness with vomiting and low blood pressure.
Expected duration
Usually two to four hours in theatre, with a typical hospital stay of two to four days.
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