Pituitary Tumor Surgery (Transsphenoidal Approach)

Pituitary tumor surgery is one of the most common cranial neurosurgical procedures, with pituitary lesions representing approximately 392 cases in national sampled datasets. At Nova Brain and Spine of GA, we offer expert surgical management of pituitary adenomas and related sellar/parasellar lesions.

Understanding Pituitary Tumors

The pituitary gland is a pea-sized gland at the base of the brain that controls hormone production throughout the body. Pituitary adenomas are almost always benign growths that can cause problems in two ways:

• Hormonal overproduction: Excess growth hormone (acromegaly), cortisol (Cushing's disease), or prolactin (prolactinoma)
• Mass effect: Compression of the optic nerves/chiasm causing vision loss, or compression of normal pituitary tissue causing hormone deficiency

Types of Pituitary Adenomas

• Prolactinoma: Most common pituitary tumor; often treated medically with cabergoline
• Non-functioning adenoma: No hormone excess; presents with vision loss or headache
• Growth hormone-secreting: Causes acromegaly (enlarged hands, feet, facial features)
• ACTH-secreting: Causes Cushing's disease (weight gain, diabetes, hypertension, osteoporosis)
• TSH-secreting: Rare; causes hyperthyroidism

Transsphenoidal Surgery

The standard approach for pituitary tumor removal is the endoscopic endonasal transsphenoidal approach — accessing the tumor through the nose and sphenoid sinus without any external incisions.

Advantages of Endoscopic Approach

• No external incisions or visible scars
• Excellent visualization with HD endoscope
• Shorter hospital stay (1-2 days)
• Faster recovery compared to craniotomy
• High cure rates for hormone-secreting tumors

The Procedure

1. Endoscope inserted through the nostril into the sphenoid sinus
2. Sellar floor opened to expose the pituitary gland
3. Tumor carefully dissected from normal pituitary tissue
4. Sellar floor reconstructed (with fat graft and/or tissue flap if needed to prevent CSF leak)
5. Nasal packing may be placed temporarily

When Surgery Is Recommended

• Vision loss from optic chiasm compression (urgent indication)
• Cushing's disease: Surgery is first-line treatment
• Acromegaly: Surgery is first-line for most patients
• Prolactinoma: Surgery when medication-intolerant or medication-resistant
• Non-functioning adenoma: When causing symptoms or growing on surveillance MRI
• Pituitary apoplexy: Emergency hemorrhage into a pituitary tumor

Outcomes & Success Rates

• Microadenomas (<10mm): 80-90% hormonal cure rate
• Macroadenomas (>10mm): 50-70% hormonal cure rate; gross total resection achieved in majority
• Vision recovery: Over 80% of patients experience significant visual improvement after surgery
• CSF leak rate: Less than 3% with modern reconstruction techniques

Post-Operative Care

• Endocrine testing at 6 weeks and 3 months post-surgery
• MRI surveillance at 3 months, then annually
• Hormone replacement if pituitary insufficiency develops
• Nasal care instructions and activity restrictions for 4-6 weeks

Nova Brain and Spine of GA provides comprehensive pituitary tumor evaluation, surgery, and long-term endocrine management for patients across Southern Georgia.