Surgical Approach to Pituitary Tumors

Question 1

Treatment of pituitary tumors

Answer 1

Medical therapy:
Prolactinomas
GH secreting tumors (usually after surgical debulking)

Surgery

Radiation

Careful observation

Question 2

What is the goal of surgery in the treatment of pituitary tumors?

Answer 2

1. Diagnosis

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

Question 3

What are the symptoms of mass effect?

Answer 3

Headache
Vision loss (peripheral visual fields usually)
Pituitary hormone dysfunction
Cranial Nerve Abn

Question 4

What tumors are surgery appropriate for?

Answer 4

Surgery is generally the first line of treatment for all pituitary tumors except for tumors that secrete prolactin.
T
umors that secrete both prolactin and growth hormone generally are candidates for surgical intervention

Question 5

The two main surgical approaches to a pituitary adenoma

Answer 5

Transnasal Microscopic Approach: Just neurosurgeon and used for tumors right in center of sellar area

Transnasal Endoscopic Approach: Required ENT and neurosurgery teams; used for tumors that might be growing off center where more visualization is needed

Question 6

What are the risks associated with surgery?

Answer 6

Rare now with transversal approaches

Post-operative spinal fluid leakage (Requires placement of spinal drain with increased hospital stay to 4-5 days.) 1%

Diabetes Insipidus

Injury to the posterior pituitary gland with inability to concentrate urine. Requires use of DDAVP. Usually transient.

Injury to Optic Nerves

Injury to the Carotid Artery (Stroke)

Injury to the Normal Pituitary Gland

Chronic sinusitis (1-2%)

Meningitis