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Pituitary Surgery for Cushing’s

During the Patient Education Day, Dr. Nelson Oyesiku gave a presentation on pituitary surgery. Dr. Oyesiku pointed out that the pituitary gland, while very important, is very small, just a little over half an inch. This makes the operating area very small and the surgical difficulty is increased because the pituitary is surrounded by many other important structures such as the optic nerves, carotid arteries and the stalk of the pituitary which contains nerve fibers to the brain. Thus, it is highly important to have an experienced surgeon.

Dr. Nelson Oyesiku, Pituitary Neurosurgeon at Emory University, Atlanta, GA

The Surgery

Pituitary surgery can be done using either a microscope or an endoscope and Dr. Oyesiku discussed the differences between the two. The most direct way to the pituitary is through the nose and the sphenoid sinus. This approach requires a wide opening of the sella, the bone that separates the sphenoid sinus from the pituitary. The first step is getting access to the gland and then a careful, systematic, complete exploration of the gland is done, particularly in patients with normal MRIs. The goal is to remove only the tumor and leave a functional pituitary gland. Dr. Oyesiku than showed videos of microscopic, 2D endoscopic, and 3D endoscopic pituitary surgery, which is the technique now used at Emory.

Results

He then presented the results of a 5 year period showing that 65/68 patients (95.5%) with Cushing’s disease achieved remission with surgery. Four of six patients (66%) that had previous surgery elsewhere were cured by a second surgery at Emory. Again, this points out the value of having an experienced pituitary surgeon. He then stressed the need for biochemical tests to determine cure in the early days following surgery as well as follow up.

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