Types of Pituitary Surgery
There are two types of pituitary surgery including the minimally invasive endoscopic transsphenoidal approach and the transcranial approach, also known as craniotomy.
Minimally invasive endoscopic transsphenoidal surgery enables the doctor to remove the tumor through the nose and sinuses, without the need for an external incision. The technique uses the nostrils as a natural portal to the pituitary gland without the need for an external incision. The doctor works through the nostrils with a tiny camera and a light called an endoscope. An opening is made in the nasal septum, sphenoid sinus, and sella to reach the pituitary. Once the pituitary is exposed, the doctor removes the tumor. Remaining areas of the brain are unaffected, and the procedure leaves no visible scar.
This procedure is conducted with a team of neurosurgeons and ear, nose, and throat (ENT) surgeons.
You may be a candidate for transsphenoidal surgery if you have:
- Pituitary Adenoma – Pituitary adenoma is an uncommon, non-cancerous (or benign) tumor that develops on the pituitary gland. They are classified according to size:
- Microadenomas are smaller than one centimeter across, rarely press on other tissue, but can cause symptoms if they release too much of a certain hormone into the bloodstream.
- Macroadenomas are larger than one centimeter across, can affect hormone production, and are large enough to press on nearby tissue or nerves, causing damage.
- Acromegaly – Acromegaly is a rare hormonal disorder that often develops when the pituitary gland produces excess growth hormone during adulthood. It usually affects middle-aged adults.
- Cushing’s Disease – Cushing’s disease is a serious hormonal disorder caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH), resulting in overproduction of the steroid hormone cortisol in the blood level. ACTH stimulates the adrenal gland that is located on top of the kidneys to produce cortisol, commonly known as the stress hormone.
- Craniopharyngioma – Craniopharyngioma is a skull based benign or non-cancerous tumor that develops in the pituitary gland. This slow-growing tumor is commonly found in children up to age 14 and adults over age 45.
- Rathke’s Cleft Cyst – Rathke’s cleft cysts are a benign formations with a thin membrane filled with fluid—they are not actual tumors. If the intersection of the anterior and posterior sections of the pituitary gland do not close during fetal development as they should, a large cyst called the Rathke’s cleft cyst will develop.
- Meningioma – A meningioma is a tumor that arises from the membranes that surround your brain and spinal cord. Most meningiomas are benign, though in rare cases a meningioma may be malignant. Some meningiomas are classified as atypical, which means they are neither benign nor malignant but, rather, something in between. Meningiomas occur most commonly in older women, but can occur in males and at any age, including childhood.
- Hypopituitarism – Hypopituitarism is a rare condition in which your pituitary gland doesn’t make enough of certain hormones. The body cannot function properly when important glands don’t get the hormones they need from your pituitary gland.
The vast majority of pituitary tumors can safely be removed through the endoscopic, transsphenoidal route. Exceedingly large tumors may be difficult to remove endoscopically, however, especially in cases where the tumor has spread to adjacent nerves or brain tissue. In these rare cases, a more extensive operation may be required that uses a craniotomy combined with skull base approaches.
Supraorbital eyebrow craniotomy is a safe and effective approach used to remove metastatic brain tumors, gliomas, meningiomas and craniopharyngiomas located along the subfrontal section of the brain or around the pituitary gland, which are close to the optic nerve or vital arteries. This approach requires a small incision within the eyebrow line.
For prolactinoma, surgery may not be required as this type of tumor responds well to medication and close observation with periodic MRI to monitor tumor growth.