Surgery for Pituitary Tumors

Neurosurgeons at NYU Langone perform surgery to remove pituitary tumors while sparing as many of the healthy parts of the gland as possible. This enables the gland to continue to release the appropriate levels of hormones, which are necessary for many of the body’s functions.

Surgery is often the first treatment used to remove pituitary tumors responsible for Cushing’s disease, acromegaly, secondary hyperthyroidism, hypopituitarism, vision problems, or tumors that are cancerous. Surgery may also be necessary in rare emergencies, such as destruction or bleeding into the pituitary gland.

Guidance and Monitoring

Surgery for pituitary tumors is often guided by computer software that incorporates MRI and CT scans. The system works much like a global positioning system (GPS) found in cars. It helps neurosurgeons locate and remove tumors with great precision while avoiding damage to the brain, major blood vessels, and the optic nerves, which run from the eyes to the brain.

Types of Pituitary Surgery

Neurosurgeons use two main approaches to removing pituitary tumors: endoscopic endonasal surgery and open surgery, or craniotomy.

Endoscopic Endonasal Surgery

Endoscopic endonasal surgery is minimally invasive, meaning doctors do not make any incisions in the skull. A surgeon places an endoscope—a long, thin, lighted tube with a tiny camera attached to it—through the nose. He or she guides it into the nasal cavity—the empty space behind the nose that filters and moistens air—and into the sphenoid sinuses. The sphenoid sinuses, which function much like the nasal cavity, sit at the base of the skull, just below the pituitary gland.

The endoscope enables a doctor to see the tumor and the surrounding structures, including important nerves and blood vessels. The surgeon places surgical tools through the scope to remove as much of the tumor as possible. A team of neurosurgeons, who perform surgery on people with nervous system problems, and surgical otolaryngologists, who specialize in ear, nose, and throat surgery, usually perform the procedure. Endoscopic endonasal surgery requires general anesthesia.

This procedure enables physicians to repair holes underneath the skull, or skull base, that may have been created while the tumor was being removed. Such openings can cause cerebrospinal fluid, the liquid that cushions the brain and spinal cord, to leak.

These holes can be plugged with a synthetic substance similar to natural tissue, a small piece of fat taken from the abdomen, or a portion of tissue from the nose that is still attached to surrounding blood vessels. Using tissue that still has a blood supply helps the holes heal more quickly.

Open Surgery

In rare situations where a pituitary tumor is very large, growing upward into brain tissue, and can’t be reached easily with endoscopic nasal surgery, doctors may need to perform open surgery, also called a craniotomy.

During this procedure, surgeons remove a portion of bone in the skull and gently separate the lobes, or sections, of the brain to remove as much of the tumor as possible. Afterward, surgeons close the hole with the removed portion of skull. Craniotomy is most often performed using general anesthesia.

What to Expect After Surgery

The hospital stay after endoscopic nasal surgery is usually two days but can extend to up to four or five, depending on how large the pituitary tumor is and where it is located. Generally, endoscopic endonasal surgery requires less recovery time than a craniotomy.