Pituitary Disorder
Treatments

Transsphenoidal means "through the sphenoid sinus." The sphenoid sinus is one of the air spaces behind the nose. Most pituitary tumors can be surgically removed transsphenoidally using a microscope or an endoscope. Most of these procedures are done through the nose (transnasally), although the sphenoid sinus may also be reached through an incision under the upper lip.

Since transsphenoidal techniques access the pituitary gland through the nose, both a pituitary neurosurgeon and an ENT surgeon may jointly perform your surgery. The pituitary neurosurgeon will perform the pituitary surgery on the gland and brain to remove the tumor.

Patient Benefits:

• The procedure is minimally invasive, meaning less postoperative discomfort, fewer complications, and a shorter recovery period.
• Transsphenoidal surgery alleviates the need to fully open the skull, meaning fewer risks for neurologic injury because of less exposure of the brain and less operating time.
• Hospital stays are relatively short, and you can return to normal activities several weeks after surgery depending on the indications for surgery and your postoperative progress.
• Patients who have pituitary tumors removed using this technique generally have excellent outcomes in experienced hands.

Patient Risks:

• A potential risk in removing a pituitary tumor is damage to the pituitary gland, which may result in the need for hormone replacement therapy.
• Damage to the posterior pituitary may result in a condition called diabetes insipidus, which may or may not be permanent.
• Rarely, a cerebrospinal fluid leak may occur, which can lead to meningitis. Surgery may be required to repair the leak.
• Even less likely, the carotid arteries, located on either side of the pituitary gland, can be damaged during surgery, leading to a stroke or blood loss.
• Damage to the structures of the sinus can result in nasal deformity and sinus congestion.

The Emory Pituitary Center is among the first to use a 3-D endoscope to remove pituitary tumors. This new surgical tool provides 3-dimensional (stereoscopic vision) through a small fiber optic camera at the end of a narrow tube, which allows the doctor to better navigate this delicate area at the base of the brain.

Although the pituitary gland is small, just over half an inch, it is an extremely important organ and is surrounded by critical nerves and blood vessels within a very narrow confined space at the base of the brain. It controls all other endocrine organs, such as the pancreas, adrenal, thyroid, testicles, and ovaries. Thus, problems with this gland can cause system-wide effects that can be a matter of life and death.

The new 3-D endoscope is extremely helpful for a surgeon who is operating on a small organ located at the base of brain. The pituitary is surrounded by nerves that control the eye and vessels that supply blood to the brain. Three-D imaging gives the surgeon critical depth perception, which optimizes hand-eye coordination. It provides the surgeon with the critical ability to accurately visualize and appreciate differences in form, shape and size as well as the relationships and distances between critical structures such as the gland, nerves and blood vessels in the operating field.

This tool has only recently become available, and Emory is one a handful of centers worldwide using it.

Patient Benefits:

• Your surgery will be performed by experienced surgeons using the best instrument on the market.
• There is less chance of disturbing other structures, such as nerves and blood vessels, because the surgeon can visualize and understand the spatial relationships without unnecessary and misleading visual distortion.
• The procedure is minimally invasive. The entire operation is done through the nose.
• This novel treatment alleviates the need to fully open the skull, meaning fewer risks for neurologic injury because of less exposure of the brain and less operating time.
• Much shorter recovery times mean you can return to normal activities several days after surgery.
• Patients who have these tumors removed using this minimally invasive technique have excellent outcomes in experienced hands.

Patient Risks:

• The risks associated with use of the 3-D endoscope are the same as with traditional transsphenoidal endoscopic surgery, but these risks are reduced.
• A potential risk in removing a pituitary tumor is damage to the pituitary gland, which may result in the need for hormone replacement therapy.
• Damage to the posterior pituitary may result in a condition called diabetes insipidus, which may or may not be permanent.
• Rarely, a cerebrospinal fluid leak may occur, which can lead to meningitis. Surgery may be required to repair the leak.
• Even less likely, the carotid arteries, located on either side of the pituitary gland, can be damaged during surgery, leading to a stroke or blood loss.
• Damage to the structures of the sinus can result in nasal deformity and sinus congestion.

If a pituitary tumor has grown particularly large or cannot be removed transsphenoidally, a craniotomy may be necessary. A craniotomy is a surgical procedure in which a bone flap is removed from the skull to reach the tumor.

Patient Benefits:

• In certain situations, craniotomy is the safest and most effective means of removing a pituitary tumor.

Patient Risks:

• A potential risk in removing a pituitary tumor is damage to the pituitary gland, which may result in the need for hormone replacement therapy.
• Damage to the posterior pituitary may result in a condition called diabetes insipidus, which may or may not be permanent.
• Patients occasionally experience seizures after a craniotomy, which may require anticonvulsant therapy.
• Rarely, a cerebrospinal fluid leak may occur, which can lead to meningitis. Surgery may be required to repair the leak.
• Even less likely, the carotid arteries, located on either side of the pituitary, can be damaged during surgery, leading to a stroke or blood loss.
• Postoperative brain swelling or blood clots can occur.

When a pituitary tumor cannot be removed completely by surgery or treated with medications, radiosurgery may be considered. In radiosurgery, highly focused beams of radiation are used to treat the tumor. Emory's treatment system consists of a device which rotates around the patient and can deliver radiation at any angle, along with a device that shapes the radiation beam to match the shape and dimensions of the tumor. The system is so precise that it can target an area within four tenths of a millimeter. This means the radiation will be delivered effectively to the tumor, while sparing surrounding tissues.

Radiosurgery, like all forms of radiation, is a treatment that works gradually. Your team of pituitary doctors will work with you to determine if your symptoms are severe enough to warrant another, more fast-acting, form of treatment.

Patient Benefits:

• Because of its precision, radiosurgery offers maximum treatment capability with minimal effect on healthy tissues.
• Radiosurgery is performed on an outpatient basis, and you can resume your regular activities within a day or two.
• Because there is no incision, there is no risk of postoperative infection or bleeding, and discomfort is minimal.
• Side effects of treatment are minimal.

Patient Risks:

• Swelling or edema may occur.
• Skin in the treatment area may become red, irritated or sensitive. It may later itch, blister or peel.