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The transsphenoidal approach involves making a small incision under the upper lip (above the upper teeth) or along the nasal septum (the cartilage between the 2 sides of the nose). Mr. D'Urso then advances along the septum back toward the sphenoid sinus. This is a hollow compartment, and its back wall covers the pituitary gland. To reach the pituitary, Mr. D'Urso opens the boney walls of the sphenoid sinus with small surgical chisels, drills, or other bone dissecting instruments depending on the thickness of the bone and sinus. This approach is usually the procedure of choice because it is less invasive, has fewer side effects, and patients generally recover more quickly. Patients can often leave the hospital as early as two to four days after surgery.

The advantages of this approach are that no other part of the brain is touched, the neurologic complication rate is very low, and there is no visible scar. The disadvantage of this technique is that it is difficult to remove large tumors. If the tumor is a microadenoma, then the cure rates are high (greater than 80%). If the tumour is large or has invaded the nearby nerves, brain tissue or its coverings, the chances for a cure by surgery are lower.

Endoscopy is a newer, minimally invasive approach which allows neurosurgeons to utilise a tiny endoscope with a camera on the end. This allows Mr. D'Urso to see well without making an incision under the upper lip or the front part of the nasal septum (only a small incision is made in the back of the nasal septum). A tiny endoscope inserted through the nostril is placed in front of the tumour in the sphenoid sinus, and the tumour is removed with specially designed surgical tools. Postoperative discomfort is usually minimal. Endoscopic brain surgery is another surgical option for removing pituitary adenomas, but can only be utilized in certain cases.

The transcranial or craniotomy approach through the upper part of the skull is used for larger tumors that cannot be safely removed through the transsphenoidal approach. This approach is used only for large and complicated tumors. It has a higher rate of permanent neurologic complications than trans-sphenoidal surgery.

Diabetes insipidus

Diabetes insipidus is a condition that occurs when the pituitary gland does not secrete enough ADH (antidiuretic hormone). This hormone regulates urine output. Diabetes insipidus may occur as a result of the pituitary gland being disturbed during surgery. The three signs of diabetes insipidus are the following:

• increased urine output

• light yellow urine

• increased thirst

If you have these signs, report them to your nurse or Mr. D'Urso. Diabetes insipidus caused by surgery is temporary and treatable.