Monday, 15 June, 2015

"Through the Nose"

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Sharon was back at the hospital. Her pituitary tumour had regrown after her last operation many years ago. She knew from her past experience what lay ahead: "Opening up" her head, severe postoperative pain and a prolonged hospital stay. However, her doctor had a surprise for her this time - he was able to remove the tumour through her nose by way of "keyhole" surgery. "It felt so good! I couldn't believe it. I could chat and laugh with my friends by the first night after the surgery and I was discharged the very next day," said Sharon.

What are Pituitary Tumours of the Brain?
The pituitary is a small pea-sized gland located at the base of the brain just behind the nose. It sends signals to other glands in the body such as the thyroid gland, adrenal glands, ovaries and testies, directing them to produce hormones that affect metabolism, blood pressure, reproduction and other vital functions of the body. The pituitary gland also produces growth hormone for normal development of height and prolactin for milk production. A pituitary tumour is an abnormal growth of pituitary cells. Pituitary tumours tend to be slow growing and non-cancerous, but they may affect hormone production and disrupt normal body functions. The tumours may also press on the optic nerve and interfere with vision.

Invasive Brain Surgery of the Past
In the past, brain tumour removal was an invasive procedure involving scalp incision and skull removal. If the tumour was at the base of the skull eg the pituitary tumour, the brain had to be retracted to expose the tumour for removal. This procedure resulted in much post-operative pain, a prolonged hospital stay, as well as morbidity from the brain retraction or post-operative bleeding.

MIS Brain Surgery Today
With medical advances, surgery to remove pituitary tumours is now conducted by an incision at the top of the upper gum or in the front part of the nose. The surgeon then proceeds with an operating microscope and other operating instruments through the sphenoid bone and the sphenoid sinus just below the pituitary gland to remove the tumour. This route however also accounts for much of the post-operative pain and swelling in the upper gums and the nasal.

Brain Tumour Removal “through the Nose”
In an attempt to be even less invasive, the operating instruments can be inserted through the nose, thus saving the need to incise the upper gum. The procedure threads an endoscope, a miniature television camera, up one nostril into the air sinus passages and finally reaches the pituitary tumour. The endoscope when used in conjunction with an operating microscope provides a three-dimensional (3D) view, making it easier for the surgeon to pinpoint and remove the tumour. This approach essentially converts a so-called complex "brain" operation into a simple "nose" operation with minimal post-operative pain and complications. The patient is usually discharged by the second day after the operation.

Author: Dr Lee Kheng Hin


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