Pituitary tumor surgery

The pituitary gland is pea-sized organ behind the nose at the base of the brain. The pituitary gland secretes hormones that regulate different functions inside the body.

Pituitary tumors, also called pituitary adenomas, are unusual growths that develop inside the pituitary gland. They’re considered brain tumors, but they grow very slowly and they're rarely cancerous (less than 0.1%). They don’t require any medical treatment unless they’re causing irregular hormone levels. In those cases, medication can help regulate the hormones.

If pituitary tumors (adenomas) begin causing headaches, limited vision or facial pain, surgical removal may become necessary. These symptoms likely mean that the pituitary tumor (adenoma) is putting pressure on the optic nerve or other areas inside the brain, including the pituitary gland itself.

Pituitary gland tumor (adenoma) surgery

There are three types of techniques that are most often recommended for pituitary gland tumor surgery: endoscopic transnasal transsphenoidal surgery (an expanded endonasal approach), craniotomy (also called transcranial surgery) and CyberKnife® stereotactic radiosurgery.

For some, pituitary gland surgery removes the tumor completely, and they won't need any additional pituitary tumor treatment. For others, the tumor might never go away completely, or it may slowly grow back. If so, hormone replacement medication is often prescribed.

Endoscopic transnasal transsphenoidal surgery

During endoscopic transnasal transsphenoidal surgery, a neurosurgeon often partners with an ear, nose and throat (ENT) surgeon to remove the pituitary tumor (adenoma) through the nasal passages. It's the most common pituitary tumor treatment procedure.

It involves no incisions, a shorter hospital stay and faster recovery than other surgical techniques. This pituitary tumor treatment also doesn't require an external incision. It doesn’t affect other parts of the brain and causes no visible scars.

One drawback is that large pituitary tumors (adenomas) cannot be removed with endoscopic transnasal transsphenoidal surgery, especially if they’ve spread to nearby nerves, blood vessels or other parts of the brain.

What to expect during endoscopic transnasal transsphenoidal surgery

Endoscopic transnasal transsphenoidal pituitary tumor (adenoma) surgery is usually done under general anesthesia, so you’ll be asked to stop eating and drinking after midnight on the night before surgery. You also may need to stop taking some types of medications that may increase bleeding during surgery. Don't take any over-the-counter medications before surgery without telling your doctor.

The surgery usually takes a few hours. It begins by placing a tiny camera attached to a thin tube called an endoscope through the nose. In some cases, the endoscope may be inserted through an incision under the upper lip. A small opening is then made in the back wall of the sinus.

MRI may be used to make images of the pituitary gland area during the surgery to help guide the surgeons. When the pituitary area is entered, the neurosurgeon removes the pituitary tumor in small pieces. When all parts of the pituitary tumor that can be reached have been removed, the endoscope is removed.

Craniotomy surgery

A craniotomy makes it easier to reach and remove large pituitary tumors (adenomas) or those that have spread to nearby nerves or brain tissue. It also makes it easier for the surgeon to see the extent of the tumor, as well as the parts of the brain around it.

What to expect during craniotomy surgery

During a craniotomy, the surgeon cuts into the scalp and removes a small piece of bone at the front of your skull to access the pituitary tumor (adenoma). After removing the tumor, the surgeon closes the opening with the removed portion of bone.

A craniotomy is also usually performed under general anesthesia, so you’ll need to follow the same instructions beforehand as you would for endoscopic transnasal transsphenoidal surgery.

CyberKnife® stereotactic radiosurgery

This procedure uses a noninvasive, robotic system to deliver high radiation doses to pituitary tumors (adenomas) with pinpoint accuracy. It works the best for pituitary tumors (adenomas) that measure up to two centimeters in size.

What to expect during stereotactic radiosurgery

Stereotactic radiosurgery is an outpatient procedure that usually takes about 30 to 50 minutes. Patients can go home and resume normal activities the same day they undergo the procedure.

You'll need regular checkups for several years after receiving stereotactic radiosurgery to check your pituitary gland function. MRI scans are typically the main follow-up tests, along with blood tests for hormone levels (if your tumor secreted hormones).

Pituitary gland removal

Because it’s common for removal of at least a small part of the pituitary gland along with the pituitary tumor or adenoma, many people's pituitary hormone levels drop after surgery or radiation therapy. If this happens to you, your doctor will likely recommend hormone replacement therapy. If the pituitary tumor or adenoma is large, it may require removal of the entire pituitary gland.

Your specialized surgical care team

You’ll likely meet with a number of specialists before your pituitary gland tumor (adenoma) surgery. These doctors work together to determine the best procedure for you:

• Brain surgeon, also called a neurosurgeon
• Hormone disorder doctor, also called an endocrinologist
• Nose and sinus surgeon, also called an ENT surgeon
• Radiation therapy doctor, also called a radiation oncologist

Pituitary gland tumor (adenoma) surgery risks

Endoscopic transnasal transsphenoidal surgery and craniotomy are generally safe procedures. Complications are uncommon, but they can include:

• Bleeding
• Brain injury
• Damage to the pituitary gland
• Double vision or loss of vision
• Infection
• Leakage of cerebrospinal fluid
• Reaction to the medicine (anesthesia) that puts you in a sleep-like state during surgery
• Temporary headache and nasal congestion

Pituitary gland tumor (adenoma) surgery recovery

After your pituitary gland tumor surgery, you may need to stay in the hospital for a day or two, but you'll be able to return to a normal diet as long as you are taking fluids well. You'll be encouraged to get out of bed and walk as soon as you're able. While in the hospital, the amount of fluids you drink and your urine output will be tracked to evaluate pituitary function.

Once you go home, pituitary surgery recovery may include:

• Pain medication to control headaches, the most common complaint after surgery
• Restricted activities – no lifting or straining until cleared by your surgeons

Depending on the size of the tumor and the extent of your pituitary gland tumor (adenoma) surgery, you may also need to see other doctors several weeks after surgery, such as:

• A neurologist to check your brain and nerve function
• An ophthalmologist (eye doctor) to assess your vision

In the months and years following your pituitary tumor treatment, you’ll need to follow up regularly with your doctors, and get MRIs to check if the pituitary gland tumor is growing back.

Life after pituitary tumor (adenoma) surgery

Follow-up care is very important after pituitary tumor surgery. As life after pituitary tumor (adenoma) surgery goes on, be sure not to miss any visits with your health care team and follow their instructions carefully. Report any new or returning symptoms to your doctor right away. Ask questions if you don’t understand what your doctor says.