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Endoscopic Pituitary Surgery

Where is it and what does it do?. Master Gland"Regulates all other hormone pathwaysThyroidIGF-1CortisolTestosterone/ EstrogenProlactinADHSits at base of brain just below optic nerves. Symptoms of Pituitary Tumors. Hormone deficitsDue to compression of glandHormone ExcessDue to hormone-secreting tumorsGH= AcromegalyACTH= Cushing's DiseasePRL= ProlactinomaTSH= TSH-oma Visual Deficits Due to compression of optic chiasm or nervesDue to compression of cranial nerves in cavernous sinus.

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Endoscopic Pituitary Surgery

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    1. Endoscopic Pituitary Surgery

    2. Where is it and what does it do? “Master Gland” Regulates all other hormone pathways Thyroid IGF-1 Cortisol Testosterone/ Estrogen Prolactin ADH Sits at base of brain just below optic nerves

    3. Symptoms of Pituitary Tumors Hormone deficits Due to compression of gland Hormone Excess Due to hormone-secreting tumors GH= Acromegaly ACTH= Cushing’s Disease PRL= Prolactinoma TSH= TSH-oma Visual Deficits Due to compression of optic chiasm or nerves Due to compression of cranial nerves in cavernous sinus

    4. Macroadenoma

    5. Surgical Options Transcranial Transsphenoidal Combined Extended Skull Base

    6.

    7. Endonasal Transsphenoidal Approach Preferred approach for most pituitary tumors Approach pituitary through back of nose Minimal tissue destruction Utilize a rigid endoscope to illuminate and magnify

    8. Endoscope and Camera

    9. Transsphenoidal Surgery

    10. Extended Endonasal Approaches Use nasal corridor as access to skull base Useful for tumors from cribiform plate to C1 Primarily midline Meningioma Chordoma Craniopharyngioma Extensive learning curve and evolving field Great way to protect the optic nerves !

    12. Expanded Endonasal Surgery

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