A pituitary tumor is an abnormal growth of cells in the pituitary gland, a small, pea-sized organ at the base of the brain, behind the nose. This gland, often called the “master gland,” produces hormones influencing growth, metabolism, reproduction, and stress response. When a tumor develops, it can produce too much of a specific hormone, leading to various symptoms, or grow large enough to press on surrounding structures like the optic nerves, causing vision problems or headaches. Surgical removal is often considered to alleviate these symptoms, restore normal hormone levels, or prevent further damage.
Surgical Methods for Pituitary Tumor Removal
Transsphenoidal surgery is the most frequently used method for removing pituitary tumors, approaching the gland through the nose and sphenoid sinus. This minimally invasive procedure avoids external incisions, as surgeons access the tumor through a small cut inside the nose or, rarely, behind the upper lip. An endoscope or operating microscope provides magnified views of the surgical area, allowing precise tumor removal. This technique is favored for many pituitary adenomas due to less pain, shorter hospital stays, and faster recovery compared to more invasive methods.
During transsphenoidal surgery, a neurosurgeon often collaborates with an ear, nose, and throat (ENT) surgeon. They navigate through the nasal passages and the sphenoid sinus to reach the sella turcica, the bony cavity housing the pituitary gland. A small opening is made in the sphenoid sinus, and specialized instruments carefully remove the tumor. Image guidance (MRI or CT scans) may be employed to help visualize the tumor and surrounding structures, aiding in complete tumor removal.
Craniotomy, or transcranial surgery, is an alternative approach for larger or more complex pituitary tumors not effectively removed via the transsphenoidal route. This open brain surgery involves an incision in the scalp and temporary removal of a skull section (bone flap) to access the tumor. The surgeon works beneath and between the brain lobes to reach the pituitary gland and remove the tumor.
Craniotomy provides a broader view of the tumor and adjacent nerves and blood vessels, making it suitable for tumors that have spread beyond the sella turcica or are difficult to reach transsphenoidally. While more invasive than transsphenoidal surgery, it is considered safer for very large or complex tumors due to improved visualization. After tumor removal, the bone flap is replaced, and the incision is closed.
The Surgical Journey: From Preparation to Recovery
Preparation for pituitary tumor removal involves various assessments to ensure patient readiness. This includes detailed MRI scans to map the tumor’s size, location, and relationship to surrounding structures like the optic nerves. Patients also undergo endocrine tests to evaluate hormone levels and ophthalmology exams if vision is affected. Discussions with the neurosurgeon and endocrinologist provide an opportunity to understand the procedure, risks, and benefits.
On the day of surgery, patients are admitted to the hospital and receive anesthesia. Following the procedure, patients are monitored in a recovery room or intensive care unit (ICU) for 1-2 days, to observe vital signs and neurological status. Pain management addresses post-surgical discomfort, which might include headaches or nasal congestion, especially after transsphenoidal surgery.
Post-operative care focuses on managing symptoms and facilitating early recovery. Patients are encouraged to begin light activity, such as sitting and walking, to prevent complications like blood clots. After transsphenoidal surgery, nasal packing might be used temporarily, and patients are advised to avoid blowing their nose or sneezing with their mouth closed for several weeks. An endocrinologist assesses hormone levels the day after surgery to determine if hormone replacement therapy is needed.
Upon discharge, typically within 2 to 3 days for transsphenoidal procedures, patients receive instructions for home recovery. Activity restrictions are common, including avoiding strenuous activities, heavy lifting, and bending for several weeks. Fatigue is frequent in the initial weeks, gradually improving over 6 weeks or more. Follow-up appointments with the neurosurgeon and endocrinologist monitor healing, assess tumor removal, and manage hormonal needs. Long-term management may involve continued hormone replacement therapy and regular MRI scans to detect tumor recurrence.
Non-Surgical Treatment Options
Medication offers a primary or complementary treatment for some pituitary tumors, particularly those producing specific hormones. Prolactinomas, which secrete excess prolactin, respond well to dopamine agonists like cabergoline or bromocriptine. These medications mimic dopamine, inhibiting prolactin production, lowering levels, and often shrinking the tumor. Many patients with prolactinomas can manage their condition with medication alone, potentially avoiding surgery. For tumors producing growth hormone or ACTH, medications like somatostatin analogs (e.g., octreotide, pasireotide) or other hormone-blocking drugs can manage symptoms and, in some cases, shrink the tumor.
Radiation therapy is another non-surgical option, employed when surgery cannot completely remove a tumor, if a tumor recurs, or if surgery is not viable. This treatment uses high-energy rays or particles to damage tumor cells and inhibit growth. Types include conventional external beam radiation (delivered daily over several weeks) and stereotactic radiosurgery (a highly focused, single high dose). Stereotactic radiosurgery is preferred for smaller tumors away from sensitive structures like the optic nerves due to its precision.
Radiation therapy works slowly, and it can take months or even years to fully control tumor growth or normalize hormone levels. While effective in controlling tumor growth, a potential long-term side effect is the gradual decline of normal pituitary gland function, which may necessitate hormone replacement therapy in the future.
Observation, or “watch and wait,” is a strategy for small pituitary tumors not causing symptoms or secreting excessive hormones. Regular monitoring with MRI scans and hormone level checks tracks the tumor’s size and any changes. If the tumor grows or causes symptoms, other treatment options, including surgery, medication, or radiation, are considered.