Surgical Approach to Pituitary Tumors

Question 1

Goals of surgery

Answer 1

1. Diagnosis

2. Tumor removal: for cure or relief of Sx of mass effect

Question 2

Sx of mass effect

Answer 2

• HA
• Vision loss
• Pit hormone dysfunction
• Cranial nerve abnormality

Question 3

Chiasmal compression by pit tumor vision loss

Answer 3

Superior quadrants are lost first

Question 4

What pit tumors are appropriate for surgery

Answer 4

All, except, for prolactinomas , which are treated medically (usually regress after medical Tx)

Question 5

Surgical approaches

Answer 5

Transnasal endoscopic approach (Both

Transsasal microscopic approach

Question 6

Compare surgical appproaches

Answer 6

Endoscopic uses both nostrils has a much wider visual field, but you use 2D TV screen versus 3D in microscopic. Endoscopic is more destructive.

Question 7

Risks associated w/ surger

Answer 7

• Postop CSF leak (requires spinal drain/4-5 days hospital stay)
• DI (transient or permanent )
• Nerve injury
• Vascular injury
• Injury of normal gland
• Chronic sinusitis
• Meningitis