Surgery for pituitary tumors can be performed in three ways: through the nose, through an incision made under the upper lip or through the skull (a craniotomy). The surgical approach depends on the size and location of the tumor.

Endoscopic surgery (neuro-endoscopy)

With this type of surgery, an endoscope, (a tubular instrument with a built-in video camera), is inserted in the nose. Using the paranasal sinuses (natural air pockets in the skull) as a pathway, the Otolayngology team navigates the endoscope into the sphenoid sinus located beneath the pituitary gland. The neurosurgeon 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 (beneath the lip), 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 neurosurgeon is aided by the operating microscope. The neurosurgeon removes the bone beneath the gland and opens the coverings of the gland. The neurosurgeon then uses a surgical instrument, called a curette, to remove the tumor. When finished, 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, as it allows the neurosurgeon greater and safer access to the tumor. An incision is made just behind the hairline, a piece of skull is removed (this is replaced at the end of the operation), and the coverings of the brain (the dura) are opened. The brain is gently moved (retracted) 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 then 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

• Gamma Knife radiosurgery at UW Medicine's Gamma Knife Center at Harborview Medical Center can be used in some cases to deliver a single dose of radiation very accurately. This avoids multiple radiation treatments and does not deliver as much radiation to nearby areas of the brain as other forms of radiation.
• The linear accelerator (LINAC) at the University of Washington is also used for radiosurgery, especially when 8-12 doses are needed, rather than just one. This is called "fractionated stereotactic radiotherapy" (FSRT).
• Conformal radiation: When tumors are large, or near the optic nerves, standard radiation (fractionated external beam radiotherapy) is administered over three to six weeks.
  
  

Following pituitary surgery, patients with hormone-secreting tumors (“functional tumors”) are followed by their endocrinologist. Serum hormone levels are obtained to determine whether or not a surgical cure (a “chemical” cure) has been achieved. If a cure has not been achieved, radiation therapy may be indicated. Patients with non-functional tumors are evaluated with an MRI scan six weeks after surgery to determine whether or not there is residual tumor. Residual tumor my require radiation therapy.

Some people cannot have surgery due to unrelated medical problems. This is rare and can be investigated by the Anesthesia team at the University of Washington.

The prognosis for pituitary tumors depends on the size and anatomical location of the tumor. For many pituitary tumors, surgery is curative. For others, it is part of a multi-step treatment program.

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.

Although rare, all surgical and postoperative problems are taken very seriously. Every step is taken to minimize the risks of surgery. When problems do occur, a team approach is usually used to provide optimal care. For instance, infections are managed with UW Medicine's infectious diseases service.

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.

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

Surgery for pituitary tumors may be urgent or elective (can be planned when it is convenient). This depends on the symptoms and tumor size.

Patients with pituitary tumors can arrange a clinic appointment by calling our neurosurgery nursing team at 206-598-9469.