Endoscopic Pituitary Tumour Surgery
کیمرے کے ذریعے پٹیوٹری غدود کی رسولی کا آپریشنEndoscopic pituitary tumour surgery removes a growth from the pituitary gland through the nose, with no cut on the face. This operation is done by Dr. Salman Falak, consultant neurosurgeon in Lahore, with a thin camera passed through one nostril. Its aim is to take the pressure off the nerves of sight and to bring hormone levels back under control.
What the pituitary gland does and why a tumour matters
The pituitary is a gland the size of a pea that sits in a small bony pocket at the base of the brain, directly behind the nose and between the eyes. It is the body's hormone control centre and directs most of the other hormone glands, such as the thyroid and the adrenal glands. A tumour here is called an adenoma. Most adenomas are benign and grow slowly, but they cause trouble in two ways. One is by growing upwards and pressing on the nerves that carry sight from the eyes. The other is by making too much or too little of a hormone.
Patients often notice that they bump into things at the sides, or that the outer part of their vision has faded, because the crossing of the optic nerves sits just above the gland. Others come with headaches, with periods that have stopped, with milk from the breasts, with hands and feet that have grown, with a rounded face and weight gain, or with tiredness and low blood pressure from a gland that has stopped working. Some adenomas are found by chance on a scan done for another reason and cause no symptoms at all.
How Dr. Salman Falak performs the endoscopic operation
The operation is done under general anaesthesia. An endoscope, which is a thin rod with a camera and a light at its tip, is passed through one nostril to the back of the nose. The thin bone at the back of the nasal cavity is opened to reach the pocket that holds the gland, and the tumour is removed in small pieces with fine instruments while the camera shows a magnified view on a screen. The normal gland is protected as far as possible. The opening is then sealed, sometimes with a small graft of the patient's own tissue, and the nose is packed or left with a dissolvable dressing. Nothing is cut on the face and no hair is shaved.
Pituitary surgery is usually a team effort. An ENT surgeon may help with the nasal part of the approach, and an endocrinologist, a hormone specialist, checks the hormone picture before surgery and manages it afterwards. The anaesthetist watches fluids and salt balance closely, because the gland also controls how the body holds water. Most patients stay in hospital for a few days, with the first night in a closely monitored bed.
Benefits and realistic outcomes
Because the route is through the nose, there is no scar and no shaving, and recovery is usually quicker than after an operation through the skull. Many patients with pressure on the optic nerves notice clearer side vision within days, though nerves that have been compressed for a long time recover more slowly and sometimes not fully. Hormone-producing tumours may settle after surgery, and patients then need fewer medicines or none.
Realistic expectations matter. A large adenoma that has grown around the blood vessels beside the gland may not be fully removable, and a small remnant is then watched with MRI or treated with medicine or focused radiation. Some patients need hormone replacement after surgery, either for a short time or permanently, and that is managed with the endocrinologist. Dr. Salman Falak explains before the operation which of these applies to your scan, so that the family knows what a good result will look like.
Who is a candidate, and when surgery waits
Surgery is usually advised when a pituitary tumour is pressing on the optic nerves or growing on repeat scans, and when it makes growth hormone or cortisol that medicine cannot control. A tumour that has bled suddenly, with sudden severe headache and loss of vision, is an emergency and is operated on quickly.
Not every adenoma needs an operation. Small tumours found by chance, with normal vision and normal hormones, are often watched with a yearly MRI. Prolactin-producing tumours, the commonest hormone type, usually shrink with tablets and are operated on only if medicine fails or is not tolerated. A patient whose hormones are dangerously low is stabilised first with replacement before any anaesthetic. The decision rests on the MRI, the vision test and the hormone results together, never on one of them alone. Send your MRI and hormone report on WhatsApp and Dr. Salman Falak will tell you whether surgery is the right path for you.
Tests and preparation before surgery
Before a date is fixed, Dr. Salman Falak needs an MRI of the pituitary with contrast, which shows the tumour and its relation to the optic nerves and the vessels beside it. A formal visual field test by an eye specialist records how much sight is affected. A full hormone panel, usually arranged with the endocrinologist, shows which hormones are high or low. A CT scan of the sinuses is sometimes added to map the bony route through the nose. Routine blood tests, an ECG and an anaesthesia review complete the workup.
Patients on steroid replacement or thyroid tablets must keep taking them and tell the team. Blood thinners are stopped only on the doctor's instruction. Bring all previous scans and hormone reports. Patients travelling from Gujranwala, Faisalabad, Sialkot or further away can send them on WhatsApp first, so that the visit to Lahore is used for decisions and not for repeats.
Recovery and follow-up
The nose feels blocked for a week or two and there may be some bloody discharge at first. Patients are asked not to blow the nose and not to strain or bend sharply in the early weeks, because this protects the seal at the back of the nose. Saline rinses are usually started after a few days to keep the nasal passages clean. Most people are walking the day after surgery and home within a few days, and desk work is possible within a few weeks for many.
Hormone checks are the most important part of follow-up. Blood tests in the first days watch for changes in salt and water balance, and the endocrinologist repeats the hormone panel in the following weeks and months. Vision is rechecked, and an MRI is done some months after surgery to see what remains. Patients from other cities can have the later reviews by video consultation, with the reports sent ahead, and see the team in person only when a scan or an examination needs it.
Where the surgery is done
Dr. Salman Falak sees patients in Lahore at Sharif Medical City Hospital in Jati Umra on Raiwind Road, at Life Hospital in Bahria Town and at Doctor Care Hospital in Al Kabir Town. Endoscopic pituitary surgery is done in Lahore, at a hospital where the endoscopic equipment and the supporting specialists are available, and the choice is discussed with the family at the consultation. Patients from Gujranwala can meet him first at Gujranwala Medical Complex on G.T. Road on Friday, and patients from the Phool Nagar side on Tuesday. For a patient who cannot travel yet, a video consultation with the MRI and hormone reports sent beforehand is the right first step. Families from other cities usually make one trip for the admission and then keep in touch by phone and video, and the hospital stay is short enough that most can plan it around work.
Risks and how they are reduced
The main specific risks are leakage of brain fluid through the nose, which sometimes needs a second small procedure to seal; a temporary or permanent drop in one or more pituitary hormones; a period of heavy thirst and urination from a change in water balance, usually short-lived; nasal crusting or a change in the sense of smell; bleeding; infection; and, rarely, injury to the optic nerves or to the large vessels beside the gland.
They are reduced by studying the MRI and CT carefully before surgery, by the magnified endoscopic view during it, by sealing the opening well at the end, by close monitoring of fluids and salts in the first days, and by early hormone checks. Dr. Salman Falak discusses the specific risks for your case, in plain language, before consent is taken, and the family can ask as many questions as they need.
Related conditions and procedures
To understand the diagnosis first, read the page on pituitary tumours and their symptoms. Tumours elsewhere in the brain are reached through the skull instead of the nose; that is described under brain tumour surgery. The same principle of a camera through a small opening is also used in endoscopic spine surgery for disc problems.
Related procedures
Conditions this treats
Where it is done
Operations are performed in Lahore. Consultations are held in Lahore, at Gujranwala Medical Complex on Fridays and in Phool Nagar on Tuesdays, or by video for patients travelling from further away.
Questions patients ask
Is pituitary tumour surgery a major surgery?
Yes. It is a serious operation on a gland that sits next to the optic nerves and major blood vessels, and it is done under general anaesthesia in a hospital with close monitoring. At the same time the endoscopic route through the nose avoids any opening of the skull, so for the patient it usually feels far less heavy than an operation through the skull, with a shorter stay and no visible scar.
What is endoscopic removal of a pituitary tumour?
It means that the tumour is taken out through the nostril using an endoscope, a thin tube with a camera and a light, instead of through a cut in the skull. The surgeon opens the thin bone at the back of the nose, removes the tumour in pieces under magnification, and seals the opening. There is no cut on the face.
Is pituitary surgery high risk?
Every operation near the brain carries risk. The main specific ones here are a fluid leak from the nose and a change in hormone levels; injury to the optic nerves or vessels is rare. With careful planning on the MRI and a team that does this work regularly, the risk is kept low for most patients. Leaving a growing tumour untreated, especially when vision is already affected, is usually the greater risk.
What is the success rate of pituitary tumour surgery?
No honest figure covers every patient, because the result depends mostly on the size of the tumour and on whether it has grown around the vessels beside the gland. Hormone-producing types add a second question, which is whether the hormone level returns to normal. Small tumours inside the bony pocket are usually removed completely; large ones may leave a remnant that is watched or treated with medicine. Dr. Salman Falak gives you a realistic picture for your own scan instead of a percentage.
Will there be a scar on my face or head?
No. The whole operation is done through the nostril, so there is no cut on the face and no shaving of the head. The only signs afterwards are a blocked nose and some crusting for a few weeks.
We are from Gujranwala. Can we start with a video consultation?
Yes. Send the MRI and any hormone or eye reports on WhatsApp and book a video call. Dr. Salman Falak can also see you in person at his Friday OPD at Gujranwala Medical Complex. The operation itself is done in Lahore, and one planned trip is usually enough.
Do I need an endocrinologist as well as a neurosurgeon?
Almost always, yes. The endocrinologist checks hormone levels before surgery and follows them for months afterwards, and arranges replacement for any that fall low. The surgical and the hormone sides of the treatment are planned together, so the endocrinologist is part of the team from the start, and Dr. Salman Falak will ask for that input before fixing a date.
Send your MRI. Get a clear answer before you travel.
WhatsApp your reports and your city, and you will be told whether surgery is likely, which tests to bring, and which OPD is nearest to you.