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Directly done through the nose, a minimally invasive, safe and very effective surgery with absolutely no visible scars or incisions.
Surgery for pituitary tumor removal has evolved over time and has gained popularity amongst surgeons and patients alike due to its least invasive approach so far and better clinical results.
Endonasal Endoscopic Transsphenoidal approach for removal of pituitary tumor is the most advanced surgery at present.
Pituitary gland, often referred to as the master endocrine gland since it controls the hormonal secretions of most other endocrine(hormone producing) glands, is a 0.5 gms, pea sized gland at the base of the brain seated in a tiny bony space in the skull, called Sella Turcica(slight depression in the sphenoid bone).
To make you understand better, it is situated in the skull underneath the brain, behind and above the nasal passages, almost 3 inches behind the bridge of the nose.
They are well above the fleshy soft tissue of the roof of the mouth, referred to as soft palate. Optic nerves, critically important nerves from eyes to the brain, pass close by.
In medical terminology, Pituitary gland is referred to as Hypophysis. It has two parts namely Anterior pituitary and Posterior Pituitary, each with its own specific functions.
Pituitary has direct connection with an important structure of the brain, hypothalamus.
Hypothalamus secretes certain hormones that reach pituitary gland through blood vessels thereby inducing pituitary to release its own set of hormones that eventually control and influence other endocrine glands's hormones secretions.
This is the way how it works!
Pituitary Adenoma, a benign tumor, is known to constitute 10 to 25 percent of all Intracranial tumors, and is the third most common Intra cranial tumor.
Patients who have Pituitary tumor have significant morbidity due to its presence, although these tumors are rarely malignant.
A tumor is an abnormal growth of cells resulting in a growth or mass.
Pituitary tumor is the abnormal growth of the cells that starts in the pituitary gland. Most of these tumors are benign i.e., they are not cancerous or malignant; they do not invade other healthy tissues or spread.
They are referred to as Pituitary Adenomas.
Their mere presence may pose problems as they are situated below the brain and optic nerve is passing close by thereby causing vision problems and they secrete excess hormones.
Mostly, these tumors are present in the anterior or front larger part of the pituitary.
Pituitary cancers are rare.
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A1 The symptoms that a patient with pituitary tumor, Pituitory adenoma presents with, vary.
Some pituitary tumors do not even cause symptoms and that's why may go unnoticed until accidentally found during imaging done for some other reason.
Symptoms when produced, are produced by way of
Producing excess of certain hormones. Such pituitary adenomas are referred to as Functional pituitary tumors. Functional pituitary tumors, producing excess of certain hormone, the tumor gets detected early while they are small in size. The type of hormone being produced in excess determinsed the type of symptoms produced.
By virtue of pressure they put on the surrounding nerves or other structures in the brain or surrounding part of the pituitary itself. Macroadenomas, pituitary tumor of the size of more than 1cm are the ones that fall into this category. Non functional adenomas,the pituitary tumors that do not cause excess production of any particular hormone, are generally noticed when they become large in size and produce symptoms due to pressure on nearby structures or are accidentally found in MRI or CT scan of the brain done for some other reason.
The symptoms caused due to pressure on the surrounding structures are the following:
Loss of peripheral vision or side vision
Facial pain or numbness
Eyes do not move in the same direction simultaneously due to eye muscle weakness.
Patient gets Unconscious.
Thse pressure symptoms are there because of Pituitary macroadenoma(pituitary tumor of the size more than 1 cm) or Pituitary cancer (rare occurrence).
A2 Pituitary tumor surgery entails removal of any tumor on the pituitary or in its absolute proximity.
There are several surgical approaches adopted to meet the goal of the tumor removal. The best part is that there are certain approaches with a provision of "No visible incision and therefore no visible scar".
The choice of surgical approach is determined by the location of the tumor.
Tumor can be accessed either through the nose, as in endoscopic TNTS(Transnasal Transsphenoidal approach) or through the craniotomy surgery, in which the bone from the top of the skull is temporarily removed in order to access and remove the tumor.
A3 The surgery calls for team work and perfect coordination amongst a neurosurgeon, anesthetist and endocrinologist for optimal surgical outcome.
Endoscopic Transnasal Transsphenoidal (TNTS) surgical approach, if taken to carry out the surgery, an Otorhinolaryngologist(ENT surgeon) is also involved as this surgical approach involves accessing the pituitary gland through nose, sphenoid sinus.
A4 As the name suggests, in this type of surgery for the removal of pituitary tumor, the neurosurgeon access the tumor going through the sphenoid sinus, which is the part of the nasal cavity and therefore the access is directly through the nose.
Certain pituitary tumors slowly and gradually grow down into sphenoid sinus.
If you recall, we mentioned above that pituitary tumor sits in the bony depression in the sphenoid bone of the skull, Sella Turcica.
The access to the tumor can be through nostrils or through the gums.
No visible incision on the skin. It is one of the most advanced, commonly performed, safe and effective surgery. It is either called endoscopic transsphenoidal surgery or endoscopic endonasal surgery.
The name says it all. This surgical approach involves the use of a thin, flexible tube called endoscope, which has a tiny camera and light at its tip that helps the neurosurgeon in carrying out the surgery.
It is passed through nostril in order to access the sphenoid bone.
A5 Craniotomy, temporarily opening the top of the skull by removing the bone flap and carrying out the surgery for the pituitary tumor removal, is the surgeon's choice under the following circumstances.
The pituitary tumor is large enough beyond the scope of endoscopic endonasal surgery and /or it has encroached the brain deeply. In this surgical approach, an incision on the scalp is made in order to access the tumor.
A6 At times, the pituitary tumor is asymptomatic, no symptoms are there.
Either they remain there for life long without being noticed or one happens to find them through some imaging test performed for some other purpose.
Under this situation, it is better left alone and carefully watched for and surgery is not called for.
However, when they produce symtoms by virtue of secretion of excess of certain hormoned that adversely affects the body functions in one way or the other or by pressurizing and damaging healthy critical structures in its proximity such as optic nerve which is important structure for healthy vision, Surgery is the first line of treatment.
Surgery can be done alone to achieve complete removal of the pituitary tumor or may be combined with other treatment options, if complete removal was not achieved due to safety issues.
Prolactinomas, are an exception in which surgery is not done. Instead, long term medication is required for its treatment.
A7 General anesthesia is given by the anesthesiologist. Patient is put to sleep, in simple terms.
The surgeon puts in the endoscope, thin flexible tube, with light and camera, inside one of the nostril, acess the sphenoid bone at the back of the nasal cavity.
With the help of endoscope the surgeon can not only view a well lit and magnified surgical area but can also insert tinyhighly advanced instruments to carry out the surgery.
Once the access is made to the tumor, it is very carefully removed while taking care not to damage the healthy tissues nearby.
This is usually achieved by employing revolutionary computer and imaging technologies such as MRI and CT scan to create a 3D map of the structures in question. Highest precision is achieved in surgery through it.
Neurosurgeon uses the instruments to break up the tumor and aspirate its chunks.The goal of the surgeon is to remove the pituitary tumor, maximum possible while preserving the normal healthy structures nearby.
Biopsy of the tumor is also done, which means tissue sample of the pituitary tumor is taken at the time of resection and sent to the pathologist so that he/ she can confirm the diagnosis.
A8 Unlike, endoscopic endonasal surgery, here, the pituitary tumor is accessed by temporarily opening a bony flap from the top of the skull not through the nose.
A9 Pure endoscopic endonasal transsphenoidal putuitary tumor removal has proved to be highly advantageous when compared to endonasal microscopic surgical approach or endoscope assisted microscopic approach in transsphenoidal surgery for pituitary tumor removal.
Some of them are listed below
Less complications post surgery such as nasal complications; sinusitis, is a safer and most effective surgical approach
Less operative time
Offers broad operative field,panoramic view, leading to better visualization of all the vital structures during the surgery and direct access to and control of detailed anatomy.
Tumor tissue can be clearly distinguished from the normal tissue by virtue of the endoscope.
Have increased potential of complete tumor excision or removal
Early discharge from the hospital
Minimal blood loss during surgery
A10 Endoscopic surgery has lots of merits when compared to microscopic transsphenoidal pituitary adenoma removal surgery. However, there are two main limitations attached to this surgical approach namely,
It calls for a bloodless surgical field
It is difficult to learn and takes a lot of effort, so make sure that your surgeon has lots of experience and skills to perform this type of surgery in high volume of cases and brought about good results. You will be glad to know that all our neurosurgeons are well experienced and globally trained in carrying out this surgery with ease and high competence. They have delivered incredibly good results.
A11 Around 5 days
A12 The possible complications may be
Need for resurgery in case of hematoma formation or CSF(Cerebrospinal fluid) leak
Complications associated with vision
Cranial nerve injury
A13 Improvement in your symptoms such as headache and vision problems and no deterioration in hormonal status.
A14 Endocrinal or hormonal imbalances and its structural and functional effects on the patient's body need to be assessed and handled well before surgery to prevent any complications.
During the surgery, taking care of the airway, blood flow disturbances and preventing blood loss is a major goal. After the surgery, achieving the fluid and hormonal balance needs effective management by the specialists.
Thankfully, with the use of neuroimaging during the surgery and the minimally invasive surgical approach, remarkable results have been achieved post surgery.
A15 Usually, Endonasal Endoscopic Transsphenoidal surgery, a minimally invasive pituitary adenoma surgery, is done under General anesthesia.
However, your anesthesiologist is the best person to determine the type of anesthesia used for you for pituitary tumor removal surgery.
The level of hormonal disturbances due to pituitary disease and eventually their structural and functional effects on the patient are some of the factors that will guide the anesthetist in devising the most suitable plan for the anesthesia and the surgery.
In order to facilitate his decision, he will run out certain tests before the surgery and try to optimize the condition so that the surgery can be carried out without any problems.
A16 Pituitary tumors can be managed in the following ways:
Medical Management of the Pituitary Tumors
Especially considered for secretory pituitary tumors or functional pituitary tumors. The goals that the specialists wants to attain by way of medical management of the pituitary tumors is to
Reduce the hormone production
Get back to the normal pituitary function
Reduce the tumor size
Management of the Pituitary tumors through Surgery
The type of surgical approach undertaken by the specialist fall into the following three categories namely
Transseptal Transsphenoidal Surgical Approach, Microscopic
Trans Nasal TransSphenoidal Surgical Approach, Endoscopic
The best and the most advanced amongst the above three surgical approaches is the endoscopic Transsphenoidal surgical approach as it has several advantages over the other two in terms of
Even better has come up lately besides this minimally invasive approach to top it up with. Computer assisted navigation and intra operative MRI which serves the following purpose such as
Critical, important structures can be identified easily
Complete and accurate resection of the tumor can be achieved and thereby minimize the chances of occurrence of remains of tumor.
Endoscopic Endonasal Transsphenoidal surgical approach coupled with advanced imaging techniques such as intra operative MRI has proved to be a blessing for the surgeon and the patients alike as it brings better surgical outcome and increased remission rate.
Here, not to forget the knowledge, esperience, skills, expertise of the surgeon in carrying out the surgery. Always good to get the surgery done from the surgeon with good credentials and who has already conducted surgery in high volume of patients.
HealthcaretripIndia can help you find the best neurosurgeons with the best hospitals of India.
Radiation therapy for treating Pituitary tumor
Radiation therapy is utilized in order to kill tumor cells. Radiation therapy uses high energy X rays given to the targeted region, from a radiation source placed outside the body. It is recommended over surgery in the following scenarios:
Surgery is contraindicated
Pituitary tumor could not be completely taken out or has recurred.
Tumor is symptomatic and is not being adequately treated with the help of medicines.
Radiation Oncologist gives the radiation therapy to the patient. It is given around 5 times a week for nearly 4 to 6 weeks.
It seems more or less like an x ray, however, the radiation dose delivered to the targeted area is much higher.
It is a painless therapy.
Duration of each radiation therapy session is generally 15 to 30 minutes. Radiation therapy comes with its own share of setbacks.
Your specialist will determine if it is a suitable treatment option for you.
Dr Rajendra Prasad
MBBS,FRCS(Glas.), FRCS(SN), CCST
Indraprastha Apollo Hospital, New Delhi
Dr K.S Narang
M.B.B.S,M.S(GeneralSurgery), M.Ch (Neurosurgery)
Minimally Invasive Spine Surgery,Wooridul Spine Hospital, Seoul, Korea
Consultant – Neurosurgeon, Institute of Neurosciences
Medanta – The Medicity,Gurgaon, Delhi-NCR
Dr Mazda K Turel
Wockhardt Hospital, Mumbai
Dr (Maj Gen) Prakash Singh
MBBS, MS(Surgery), Mch(Neurosurgery)
Director & Sr. Consultant Neurosurgery
Max Smart Super Specialty Hospital,Saket,New Delhi
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