The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic transsphenoidal pituitary adenoma resection.
The pituitary gland is a small structure attached to the base of the brain behind the nose, where it is protected by a part of the skull called the sphenoid bone.
Pituitary adenomas are benign slow-growing tumours that arise within the pituitary gland. Most pituitary adenomas are microadenomas, or small tumours, although a few patients have macroadenomas, which are larger.
The treatment options for pituitary adenomas include surgery, drugs and radiotherapy.
Endoscopic transsphenoidal pituitary adenoma resection is carried out under general anaesthetic. An endoscope is inserted into the nostril towards the base of the tumour at the skull base.
Surgical instruments are then inserted next to the endoscope through the same nostril. The tumour is removed and the bony floor of the space occupied by the pituitary is closed.
Patients usually undergo the procedure via the right nostril, however surgery is sometimes done via the left nostril, depending on the location of the tumour.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.