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A Discussion with Dr. Ryan Gallivan on endoscopic removal of pituitary and sinus tumors 

Dr. Kent Yundt is a Neurosurgeon with over ten years of experience in neurosurgery research and progressive surgical care for spine and brain disorders. He is currently Chief of Surgery at St. Charles Medical Center and heads up a practice that books over 2000 patient visits a year. This series of articles will discuss advancements in medicine along with the physicians associated with the treatment topic.

When it comes to surgery on the throat, sinuses, mouth or ears an otolaryngologist is the one you want to see. Better known as an ENT (Ear, Nose and Throat) specialist, these doctors work closely with neurosurgeons when dealing with operations near or around the brain such as tumors involving the sinuses or the pituitary gland.

Dr. Ryan Gallivan is an ENT doctor specializing in minimally invasive endoscopic surgery of the sinuses and anterior skull base.  In Central Oregon he is the only ENT performing purely endoscopic removal of pituitary tumors. This is still a cutting edge technology performed by only approximately 1% of the specialists in the country.

The reason pituitary tumors are still removed with the invasive practices of “degloving” (peeling back) the nose, breaking the septum and making a large hole for microscope viewing, is because most neurosurgeons have not been trained extensively using endoscopic techniques. Neurosurgeons are accustomed to working through a microscopic positioned over the exposed surgical area. While the end result of removing the tumor may be the same, the invasiveness and risk of complications are much greater than with endoscopic surgery.

In the case of purely endoscopic surgery, a thin rod with a camera lens on the end is inserted through the nostril, into the sinus cavities and up into the area in which the pituitary gland sits. There is only a small piece of bone that must be removed and there is no cutting of skin and very little post-operative pain. Most patients are ready to go home from the hospital after a purely endoscopic procedure one day after surgery. With the traditional methods, patients spend up to five days in the hospital. Complications such as a hole in the septum, loss of teeth (if the surgery was done through the upper lip), and abscesses can be completely avoided when the tumor is removed endoscopically through the nostril.

Take the case of Kyle Presley. This 10-year-old boy had a massive vascular tumor extending from the tip of his nose deep into his head.  The tumor approached his right eye, and was adjacent to his brain and carotid artery.  It had to be removed – if left to continue it would grow into his brain and be irremovable. The Presley’s were sent to Dr. Gallivan, and contrary to classic open techniques, he opted to remove the tumor endoscopically. Although the surgery lasted about 5-6 hours longer than the traditional method of cutting one side of the face open, Kyle was saved from a 6-inch scar across his nose and cheek, nerve damage to one side of his face and the possible complications of infection and life long sinus troubles. Kyle is fully recovered, has no side effects and is working to become part of the “Sparrow Club” to help his parents pay off his medical bills.

As Dr Gallivan denotes, Central Oregon is not only a great place to live but it is a great place to get sick, especially when we have doctors doing such advance procedures. “St. Charles is one of the best hospitals that I know of – we have the talent to do anything here that is being done in larger urban areas. I’m excited to see our community progressing with the latest technologies and procedures.”

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