Endoscopic Pituitary Surgery

The endoscope—like the microscope—is a tool that helps neurosurgeons see the pituitary region better during surgery. The endoscope is a small, rigid rod that provides light and magnification from inside the sphenoid sinus. The surgeon watches a video monitor directly in front of him or her that displays the image that is coming from the endoscope. This is similar to how laparoscopic surgery is done. It is more comfortable for the surgeon and allows other people in the operating room to follow the surgery in detail.

The endoscope is small—between 0.11 and 0.16 of an inch (2.7 to 4 milimeters) in diameter. It can be threaded through the nose while leaving enough room for other surgical instruments to be introduced.

Once the endscope is in place, it can easily be moved in all directions. This gives the neurosurgeon a wider and more adjustable field of view than the microscope. In addition, the quality of the images from an endoscope is better than with a microscope. Other advantages of the endoscope include:

  • Excellent vision to the sides
  • Excellent vision from above
  • Angled lenses that allow a surgeon to see around corners
  • The ability to get closer to the pituitary gland and tumors
  • Less disruption to the tissues because the instruments are smaller

At the same time, the endoscope has some disadvantages when compared to using a microscope for pituitary surgery. These include:

  • Less ability to magnify the area being viewed
  • Lenses can get fogged

A surgeon may use both an endoscope and a microscope when doing pituitary surgery. The endoscope is used to get into the sphenoid sinus. The microscope is used to remove a pituitary tumor. In some situations, the surgeon may use the endscope for the entire procedure. In this case, the procedure is called endoscopic endonasal surgery. This method is used almost exclusively at Cedars-Sinai.