Surgical Approach to Pituitary Tumors

Question 1

Treatment Goals

Answer 1

a. Control tumor growth/mass effects
b. Preserve pituitary function
c. Prevent recurrence
d. Relieve symptoms
e. Control hormone hypersecretion
f. Improve mortality rates

Question 2

Treatment of Pituitary Tumors

Answer 2

a. Medical therapy:
i. Prolactinomas
ii. GH secreting tumors (usually after surgical debulking)

b. Surgery
c. Radiation
d. Careful observation

Question 3

Outline

Answer 3

What is the goal of surgery in the treatment of pituitary tumors.

What tumors are appropriate for surgery

Surgical approaches to the pituitary region (transnasal microscopic vs. transnasal endoscopic)

Risks associated with surgery

Question 4

What is the goal of surgery in the treatment of pituitary tumors.

Answer 4

1. Diagnosis
   i. Able to diagnose what type of tumor and what type of hormone its releasing from the pituitary
2. Tumor removal: for cure or relief of symptoms of mass effect

Question 5

Sx of mass effect:

Answer 5

1. Headache
2. Vision loss
3. Pituitary hormone dysfunction
4. Cranial Nerve Abn.

Question 6

What tumors are appropriate for surgery

Answer 6

a. Surgery is generally the first line of treatment for all pituitary tumors except for tumors that secrete prolactin.
i. if they secrete prolactin ONLY, than first line may not be surgery

b. Tumors that secrete both prolactin and growth hormone generally are candidates for surgical intervention

Question 7

Surgery is generally the first line of treatment for all pituitary tumors except…

Answer 7

a. Surgery is generally the first line of treatment for all pituitary tumors EXCEPT for tumors that secrete prolactin.
b. Tumors that secrete both prolactin and growth hormone generally are candidates for surgical intervention

Question 8

Transnasal Endoscopic Approach

Answer 8

The Set-up

Question 9

Risks associated with surgery

Answer 9

a. Post-operative spinal fluid leakage
i. Requires placement of spinal drain with increased hospital stay to 4-5 days.

b. Diabetes Insipidus
i. Injury to the posterior pituitary gland with inability to concentrate urine.
ii. Requires use of DDAVP. Usually transient.

c. Injury to Optic Nerves
d. Injury to the Carotid Artery (Stroke)
e. Injury to the Normal Pituitary Gland
f. Chronic sinusitis
g. Meningitis