Pituitary Tumors Surgery

Pituitary Tumors Surgery is done to remove pituitary tumors. The success of surgery works depends on the type of tumor, its exact location, its size, and whether it has spread into nearby structures.

Some facts about Pituitary Tumors Surgery:

• Surgery might be the only option of treatment if the pituitary tumor is benign and is located in a part of the brain where neurosurgeons can safely and completely remove it.
• Pituitary Tumors Surgery is required when the tumor is producing hormones that can not be controlled by medication, causing health issues by pressing on the pituitary gland or other parts of the nervous system or still growing despite previous treatment with medication or surgery.

Types of Pituitary Tumors Surgery:

Endonasal endoscopic surgery, Neuroendoscopic surgery and Craniotomy are the most common types of surgery for pituitary tumors.

Endonasal Endoscopic Surgery:

Endonasal endoscopic surgery is a minimally-invasive approach using which almost all benign pituitary tumors can be removed. Tumors and lesions can be removed through the nose and sinuses, without cutting the face or the skull in this procedure.
Those areas of the brain that are difficult to reach with traditional surgery can be accessed by the neurosurgeons in endonasal endoscopic surgery. An endoscope, a small telescope-like device equipped with a high-resolution video camera and a bright light is used by the neurosurgeon to perform the procedure. Special instruments are attached to the endoscope for the removal of a tumor or take a sample of it. There will be less pain and a faster recovery than traditional surgery in case of endonasal endoscopic surgery. There will not be any visible scar on the face or scalp after the surgery. Radiation therapy can be started almost immediately after the surgery if needed, without waiting for incisions to heal. Hormone secreting tumors, Nonhormone-secreting tumors as well as Cancerous tumors can be removed by Endoscopic pituitary surgery.

Neuroendoscopic surgery:

Neuroendoscopy is a minimally invasive procedure in which some pituitary tumors will be removed through a small hole in the skull or through the mouth or the nose.
Those areas of the brain that are difficult to reach with traditional surgery can be accessed by the neurosurgeons in Neuroendoscopy surgery and the tumor can be removed without cutting or harming other parts of the skull. An endoscope, a small telescope like device equipped with a high-resolution video camera and a bright light is used by the neurosurgeon to perform the procedure. Special instruments are attached to the endoscope for the removal of a tumor or take a sample of it.

Craniotomy:

An incision in the scalp of the patient will be made and a piece of bone will be removed from the skull in case of craniotomy. The tumor can then be found and removed by the neurosurgeon as much as possible without risk of severe damage to the brain. The bone will be replaced and the incision will be closed by the neurosurgeon.

Preparation for Pituitary Tumors Surgery:

• An evaluation should be done before surgery by visiting an endocrinology specialist.
• You may also have to check your vision before surgery.
• You will be asked to stop eating and drinking after midnight on the night before surgery as the surgery is usually done under general anesthesia.
• You should stop taking the medications that may increase bleeding during surgery.
• Any over the counter medications should not be taken before surgery without telling your doctor.
• Several test are performed by doctors to determine if pituitary tumor surgery can be performed on a patient and the risk for future concerns and assessments that typically occur over 1 to 3 weeks before brain tumor surgery.
• The doctor will able to decide the type of pituitary tumor surgery procedure that will be most suitable for the patient and the expected results on pituitary tumor surgery recovery based on these test.
• Some of these tests include blood tests, an electro echocardiogram (EEG), X-rays, CT scan and MRI scans.
• Image guidance with MRI or CT scans will be used by the doctor before surgery to learn as much as they can about the tumor.
• It is important for the doctor to know the size of the tumor and whether it has spread beyond the pituitary gland in order to plan the best surgical approach and predict how likely it is to take out all of the tumor.

Post-surgery Recovery:

• A team of doctors and nurses  who are specially trained in neurosurgery, endocrinology, and critical care will help the patient recover after surgery.
• You will need follow-up visit to a neurosurgeon or endocrinologist and have imaging tests performed periodically to keep an observation.
• Further treatment may be required after the surgery if the pituitary tumor grows or symptoms worsen.
• Pain medication will be provided to control headaches, the most common complaint after surgery
• Repeat MRI and visual testing will be conducted.

Possible Side Effects of Pituitary Tumors Surgery:

• Bleeding, infections, or reactions to anesthesia are some of the common risk associated with Pituitary Tumors Surgery.
• A sinus headache and congestion for up to a week or two after surgery can happen in most people who have transsphenoidal surgery.
• Brain damage, a stroke, or blindness is quite rare but may happen because of damage to large arteries, to nearby brain tissue, or to nerves near the pituitary during surgery.
• A person can get meningitis, infection and inflammation of the meninges until the temporary pathway between the nasal sinuses and airways and the brain created during transsphenoidal approach heals.
• Damage to the meninges can also lead to CSF, or cerebrospinal fluid leakage  out of the nose. Cerebrospinal fluid, is the fluid that surrounds the brain.
• Some people may develop Diabetes insipidus after the surgery. However, it usually improves on its own within a few weeks after surgery.
• Damage to the rest of the pituitary can result in other symptoms from a lack of pituitary hormones, especially after treating some larger macroadenomas.
• The lower levels of pituitary hormone after surgery can be treated with medicine to replace certain hormones that are made by the pituitary and other glands.