Pituitary Tumor: Surgery

Surgery is often the main treatment for people with pituitary tumors. The goal is to take out all of the tumor. In some cases, chemotherapy, certain medicines, or radiation may be used before surgery. This is done to shrink the tumor and make it easier to remove.

Types of surgery used to treat pituitary tumors

Pituitary tumor surgery may be done in 2 ways:

• Transsphenoidal hypophysectomy. This is the most common surgery used to remove pituitary tumors. The surgeon makes a small cut behind the upper lip or below the cartilage that divides the two side of the nose. The surgeon uses long, thin tools to make a hole through a bone in the nasal passage. This is done to get to the pituitary gland. The tumor is then removed. In this kind of surgery, no part of the brain is touched. And there is no scar that anyone can see. Another option may be to put a very tiny camera on the end of a thin, flexible tube (endoscope). The tube is put into the nose, through a hole made in the back wall of the sinus, and to the pituitary gland. Long, thin tools can then be used through the normal passages of the nose to remove the tumor.

• Craniotomy. Thismay be needed if a tumor is very large. Or it may be done if the tumor has spread to nearby nerves or to the brain. To do this, the surgeon has to open the brain through the skull. Two openings are needed: one at the front and one at the side. The surgeon works between and below parts of the brain to take out the tumor. This surgery is done using a microscope or an endoscope to see the tumor and nearby structures.

Side effects of surgery

Side effects from pituitary tumor surgery are uncommon. But some problems may occur. This includes damage to large arteries, to nearby brain tissue, or to nerves near the pituitary. In rare cases, these can cause brain damage, a stroke, or blindness.

In other rare cases, the membranes around the brain (meninges) may get infected. This is called meningitis.

Other side effects that may occur include:

• Headaches and congestion. These may occur for a week or so after transsphenoidal surgery.

• Diabetes insipidus. This condition sometimes occurs after surgery. It makes you urinate too much. The urine looks very pale, almost clear. This condition also causes severe thirst and loss of fluids (dehydration). It's caused by the lack of a hormone called ADH (antidiuretic hormone). ADH is made by the pituitary. It lets the kidneys keep healthy amounts of water rather than sending it out in urine. Diabetes insipidus often goes away in a week or 2 with no treatment. But it can be treated with a nasal spray that has medicine.

• Levels of other pituitary hormones may also be low after surgery. This may not happen after surgery for a small tumor. But it’s likely to occur when larger tumors or the entire pituitary gland are removed. Your hormone levels will be watched. You may be given hormone replacements if needed.