The Role of Surgery in the Treatment of Pituitary Tumors

Question 1

Surgery is generally the first line of treatment for all pituitary tumors except for tumors that secrete ______ . This is because medical treatment is so effective

Answer 1

prolactin

Question 2

The main surgical access to the pituitary gland is _______

Answer 2

transnasal

Question 3

The transnasal approach can be _____ or _______

Answer 3

microscopic or endoscopic

Question 4

what are the Risks associated with surgery

Answer 4

1) Post-operative spinal fluid leakage
Requires placement of spinal drain with increased hospital stay to 4-5 days.
2) Diabetes Insipidus: Injury to the posterior pituitary gland with inability to concentrate urine. Requires use of DDAVP. Usually transient.
3) Injury to Optic Nerves
4) Injury to the Carotid Artery (Stroke)
5) Injury to the Normal Pituitary Gland
6) Chronic sinusitis
7) Meningitis – very rare, even though the environment in the nose is often contaminated.

Question 5

what are the Treatment Goals of surgery

Answer 5

• Control tumor growth/mass effects
• Preserve pituitary function
• Prevent recurrence
• Relieve symptoms
• Control hormone hypersecretion
• Improve mortality rates

Question 6

What are the symptoms of mass effect

Answer 6

headache, vision loss, pituitary hormone dysfunction and cranial nerve abnormalities

Question 7

Medical therapy is available for which type of tumors?

Answer 7

prolactinomas, GH secreting