Pituitary Innovation and Teaching

St. Michael's team

Video transcript

Speaker: Dr. Michael Cusimano

The team at St. Mike’s has lots of experience doing pituitary surgery. It’s a routine operation for us. We do approximately 40 to 60 of these operations per year and we’ll see several hundred of these patients every year. The number is constantly growing and so it’s a common procedure that we undertake.

The team generally consists of endocrinologists or hormone specialists who also correspondingly has lots of experience with ear, nose, and throat specialists or surgeon who specialize in the nasal cavity and sinuses around the nose. The neurosurgeon and often an optomologist, which may or may not be at St. Michael’s hospital or a neuro-optomologist. And so the whole team has lots of experience in dealing with patients with these types of problems.

We’ve done a lot of research in the area and we clearly do a lot of education, both locally with trainees from local universities in Ontario, but also have trained neurosurgeons and other specialists around the world who come to St. Michael’s to learn the technique and to perfect the technique and take it back to their own countries.

I: How long did you say this transsphenoidal technique has been around for? Is it you that developed this specific technique?

Well the original transsphenoidal operation was done in 1908 I believe, the very first one, but obviously that was using very crude methods and it wasn’t very safe. The first one if you can believe it was not even done under a general anesthetic. Now, the methods were improved with general anesthesia but the ways of visualizing things didn’t improve really until the 1960’s when the microscope was used to do this. And so, the surgeons in the 1960’s in Montreal actually started doing the procedure with the microscope through the nose, but they often used the upper lip to get to the nose to get more room so that there was enough light to see in.

The innovation that we did was that we decided to use telescopes or what are called endoscopes in the early 1990’s. We did our first operation in the 1993 using this and we first published a few years later in 1996 about the technique. We will use both nostrils, one for the telescope or endoscope and the other one for the instruments that we use. We’ll often use instruments on both sides. We accomplish this by making a small opening at the very back of the nasal septum so that we can see and work from both sides of the nose.

This in fact was very simple idea but something that hadn’t been done before we described it in any length or detail. Since we described it people from all over the world have been incorporating it and now it’s kind of a routine operation around the world.


Page last updated: June 3, 2016