[MUSIC] Okay. Let's talk about pituitary tumors. Now, remember, here we have. We're looking at the the base of the brain. This is the back. This is the front. This is the left side and the right side. The eyes are sitting here. Remember that the eyes are sending back a optic nerve which is going to cross here in this thing, in this structure called the optic chiasm. And what's this little nubbin? Well that little nubbin is the attachment between the hypothalamus and the pituitary. This is the attachment between the hypothalamus and the pituitary. If we look for a moment, if we look for a moment at the skull, okay front, back, and we're going to be looking at this piece right here. Here are the eyes. And you can see that there's a hole back here that, that the optic nerve can go through. Can you see that? And if I turn this around, woo, look where my pointer is. It's right here, where the optic chiasm sits, this is where the optic chiasm sits. And right here, in this little indentation, that is where the pituitary sits. So the pituitary sits here, if these cells in the pituitary, if they grow, they can, can't expand down because it's bone. Their only way for them to expand is up. Up and forward. So, let's return to the brain. So, the pituitary is sitting right here in a space. It's been, it's been cutoff. But if it, if the cells start to multiply and multiply out of control, they're going to take up more and more space. It's going to press, it's going to press like that. and what am I pressing on? I'm pressing on the optic chiasm. That's a problem. I'm going to have problems with my vision, in fact, I'm going to not be able to see over here, and over there. Okay ,so I'll have, I'll be able to see in the middle bit, it's a version of, of tunnel vision. So, here's the optic, here's the pituitary where the pituitary sits, if it grows it starts to press upwards that's the only place it can go and it's going to injure. And impair the function of the optic chiasm. Ok. What are we going to do about that? Well, notice that in this skull, in this skull, here's the pituitary. That's where it's sitting. And that's where the problem is. We gotta go in there and get that. We gotta get that extra, those, those multiplying cells. So, how do we do it? Well we actually go, notice that this is very close to the front of the face, in fact it's very close to the nasal sinuses. It's. And so the approach. This is a partial piece of a skull but it enables me to show you what the surgical approach is to remove a pituitary tumor. It's called the transfenetal,transsphenoidal approach. Here are the eyes. And what the surgeon does is go, is goes in through the nasal sinuses and that brings the surgeon to right here. Do you see this, this pipecleaner right here? So it brings the surgeon right to the point where the pituitary sits. And so by going in through here, by going up through the top of the mouth and through the nose, the surgeon has a fairly. e, well relatively easy access to the pituitary. Certainly much easier than if they came down from the bot, from the top, came in from the side or came from the bottom. So, that's the approach that surgeons typically take. On this skull. Remember that the pituitary is here and this is a hop, skip, and a jump away from the nasal sinuses. So the approach is to go in through typically in through here, through underneath the upper lip and then. Feed an instrument in like that. To go right into the brain. Right into the cranium. Alright? Great. And hopefully that takes care of the, the problem. [MUSIC]
