Overview
Surgery for pituitary tumors can be performed through the nose, through an incision made under the upper lip or through the skull, called a craniotomy. The surgical approach depends on the size and location of the tumor. The UW Medicine Pituitary Program at the University of Washington Medical Center specializes in treating these tumors.
Endoscopic surgery (neuro-endoscopy)
With this type of surgery, a tubular instrument with a built-in video camera called an endoscope is inserted in the nose. Using the paranasal sinuses – the natural air pockets in the skull – as a pathway, the otolaryngology team navigates the endoscope into the sphenoid sinus located beneath the pituitary gland. The neurological surgeon then removes the thin bone beneath the gland and opens the coverings of the gland. Surgical instruments called curettes are used to remove the tumor. When finished, gauze packing is placed in the nose and the patient is transferred to the recovery room.
Sub-labial surgery
Sub-labial surgery is similar to endoscopic surgery except that an incision is made under the upper lip to gain access to the sinuses. This incision permits a wider opening than the patient's nostrils, which may be helpful in some cases. The resection of the tumor by the neurological surgeon is aided by the operating microscope. The neurological surgeon removes the bone beneath the gland and opens the coverings of the gland. A surgical instrument, called a curette, is used to remove the tumor. Gauze packing is placed in the nose, and the patient is transferred to the recovery room.
Craniotomy
A craniotomy is when a piece of the skull is removed to gain access to the pituitary tumor beneath the brain. For most tumors, this approach is not needed. However, craniotomy is helpful in cases where the tumor has grown beyond the normal pituitary position because it gives the neurological surgeon greater and safer access to the tumor.
An incision is made just behind the hairline, a piece of skull is removed, and the coverings of the brain are opened. The brain is gently moved to gain access to the pituitary tumor. After the tumor is removed, the skull piece is replaced and secured with titanium plates and screws. The patient is transferred to the recovery room.
Radiation therapy
When tumors cannot be treated adequately with medications or surgery, radiotherapy is often used. The type of radiation needed depends on the size and location of the tumor.
Types of radiation therapy
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Gamma knife radiosurgery
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Linear accelerator (LINAC)
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Conformal radiation
Procedural Details
Patients with hormone-secreting tumors, also called functional tumors, are followed by their endocrinologist after surgery. Serum hormone levels are obtained to determine whether a surgical cure has been achieved. If a cure has not been achieved, radiation therapy may be indicated. Patients with nonfunctional tumors are evaluated with an MRI scan six weeks after surgery to determine whether there is residual tumor. Residual tumor may require radiation therapy.
Considerations
Some people cannot have surgery due to unrelated medical problems. This is rare and can be investigated by the anesthesia team.
Effectiveness
The prognosis for pituitary tumors depends on the size and anatomical location of the tumor. Surgery is curative for many pituitary tumors. For others, it is part of a multi-step treatment program.
Risks
The risks of surgery differ depending on the approach used, the type and size of the tumor, the tumor location and the patient's general health. Surgical and postoperative problems are rare, but are taken very seriously. In these cases, a team approach is used to provide optimal care.
The rehabilitation medicine service becomes involved whenever appropriate, providing speech therapy, physical therapy, occupational therapy and other services that help patients improve the quality of their lives.
Risks of not having this treatment
Pituitary tumors can grow if not treated surgically. This growth can lead to worsened symptoms and can make a tumor incurable by surgery. Hormone-secreting tumors cause over secretion of a hormone. This is detrimental to the patient’s health and may even shorten the patient’s life.
Urgency
Surgery for pituitary tumors may be urgent or planned. This depends on the symptoms and tumor size.
Patients with pituitary tumors can arrange a clinic appointment with the UW Medicine Pituitary Program