Endoscopic Surgery to Remove a Pituitary Tumor

Tumors in the pituitary gland are common, with 10,000 of them diagnosed each year. Most are benign adenomas and may not cause any problems. However, if a pituitary tumor is malignant or if it is benign but causing problems, its removal may be required. Endoscopic transphenoidal surgery is a non-invasive, superior way to remove such a tumor.

What Is the Pituitary Gland?

The pituitary gland is a pea-sized gland that sits below the brain, just behind the nasal passages, near the optic nerve. The gland is sometimes called the “master control gland” because it helps control the levels of hormones made by other endocrine glands in the body. These hormones travel through the bloodstream to the cells, helping control growth, development, metabolism, reproduction and how organs work.

Symptoms of a Pituitary Tumor

When a tumor forms in the pituitary gland, it can compress nearby structures such as the optic nerves, optic chiasm and/or nerves that control eye movements, leading to vision loss or double vision. A tumor also can cause abnormal endocrine function by producing elevated hormone levels or diminished production of hormones due to normal gland dysfunction.

Because of the hormonal influence of the pituitary gland, symptoms of a tumor can occur throughout the body. Common symptoms are:

• Loss of peripheral vision due to compression of the optic chiasm
• Double vision due to compression of the nerves that control eye movement
• Headaches
• Unexpected weight gain
• Increased hand or foot size
• Round face or increase in jaw size
• Increased abdominal size with large abdominal striations or ridges
• Unusual intolerance to heat or cold
• Loss of libido
• In women, lactation without a newborn or loss of normal menstrual cycle
• In men, erectile dysfunction

Types of Surgery to Remove Pituitary Tumors

Several methods are available to remove a pituitary tumor, including the open transcranial approach, microscopic transsphenoidal approach and the most recently developed one, the endoscopic transsphenoidal surgery.

With the endoscopic transsphenoidal approach, the microscopic imaging device and a light source (the endoscope) are inserted into the surgical site. This provides the surgeon with a wider angle of view and better visualization, as compared to the microscopic transsphenoidal approach. Compared to an open transcranial approach, the endoscopic transsphenoidal approach avoids brain exposure and retraction.

Using the endoscope, your surgeon can see around corners using angled view scopes. This improves the rate of removal of these tumors, minimizing residual tumor and helps preserve the normal residual pituitary gland. Endoscopic surgery leads to faster recovery times compared to open transcranial approaches. Larger tumors, that in the past would have required the open transcranial approach, can be safely removed with the endoscopic approach, which also leads to improved postoperative nasal function versus traditional microscopic transsphenoidal approach.

How the Endoscopic Surgery Is Performed

When performing this procedure, the neurosurgeon often works with an ear, nose and throat (ENT) specialist who holds the scope during the tumor resection. After you are under anesthesia and positioned properly, the surgeon starts by opening the normal nasal passages to reach the pituitary and provide room to use the surgical instruments. Once inside the sphenoid sinus where the pituitary tumor is located, the surgeon and ENT specialist work simultaneously to remove the tumor. This reduces the time needed for surgery. After the tumor is adequately removed, the neurosurgeon closes the opening made to reach the pituitary tumor and the ENT specialist restores the nasal anatomy.

While the endoscopic transsphenoidal approach offers a minimally invasive way of removing pituitary tumors, and any adjacent tumors, it does have a steep learning curve. The best results are achieved by surgeons who have undergone specific training in this kind of surgery.

By doing this surgery as a team approach with ENT and neurosurgery, patients receive comprehensive care with the neurosurgeon managing the neurosurgical aspects of the care, and the ENT managing and improving the nasal sinonasal recovery of surgery.

If you have a symptomatic pituitary tumor and can tolerate routine general anesthesia, you would be a good candidate for this procedure.