About Pituitary Tumor Surgery

Surgery is the primary treatment for tumors on your pituitary gland.

These tumors are benign (not cancerous) in more than 99 percent of cases, according to the University of Virginia School of Medicine. But they can still cause problems with your hormone levels and lead to vision problems if the tumors push on your optic nerves.

It’s not exactly clear how prevalent these tumors are. But a nationwide Icelandic study found a prevalence of about 116 per 100,000 people.

Treatment for pituitary tumors is usually needed if they’re causing disruptive symptoms. The most common surgical techniques are called transsphenoidal surgery and craniotomy.

Transsphenoidal surgery

Transsphenoidal surgery is used more often than other procedures to remove pituitary tumors. With this technique, a surgeon removes the tumor through a hollow space in your sphenoid bone, which is at the back of your nasal passages.

The exact method that surgeons use to perform this technique varies, according to the American Cancer Society (ACS). But it usually follows these steps:

1. A surgeon makes an incision along the cartilage that separates each side of your nose, called your nasal septum.
2. Using a small surgical instrument, they open the sphenoid bone and a hollow part of this bone called the sphenoid sinus at the back of your nasal passages. Your pituitary gland sits in a notch at the top of this bone.
3. The surgeon then uses small tools and a microscope to remove the tumor from your pituitary gland.

Alternatively, surgeons sometimes use an endoscope, which is a thin and flexible tube with a camera. Using an endoscope avoids the need to cut through the nasal septum.

Craniotomy

Craniotomy may be necessary for larger tumors or tumors that are more difficult to remove. Although this procedure has a higher risk of brain injury, it’s often safer for large tumors because the surgeon can directly see the tumor.

This technique involves the following steps:

1. Your surgeon makes an opening at the front of your skull on one side.
2. They then carefully work beneath your brain to reach the tumor.
3. The surgeon will then delicately remove the tumor.

Surgery of your pituitary gland is generally safe when performed by an experienced surgeon, but it’s still a major procedure. Like all surgeries, it comes with some risks.

Complications of pituitary tumor surgery are uncommon. If the tumor isn’t successfully removed, you may require a second surgery.

Most people have a sinus headache or congestion for 1 or 2 weeks after surgery, according to the ACS.

Other potential risks include:

• reaction to general anesthesia
• damage to brain tissue
• leakage of cerebrospinal fluid
• meningitis, an infection of the brain’s outer membrane
• damage to the pituitary gland that can cause hormone imbalances
• diabetes insipidus, which can cause frequent urination and unusual thirst
• severe bleeding
• vision problems

Your doctor will want to monitor you closely after your procedure. MRI and hormone tests are the most common follow-up tests.

If you had a tumor that was producing excess hormones, you’ll have hormone tests done within days or weeks to see if the treatment was successful.

Blood tests will help show if the remaining part of your pituitary gland is acting the way that it should. Even if the results are typical, you’ll continue to visit your doctor regularly to see how your hormone levels change with time. If there are signs that the tumor has come back, you may need another surgery.

You may need radiation therapy if part of a cancerous tumor cannot be removed during surgery. It’s hard to predict how your tumor will respond to radiation, so you’ll likely need follow-up visits with your doctor for several years.

If your pituitary hormones are low, which is common after surgery, you may need to take hormone replacements.

Here are some frequently asked questions about pituitary tumor surgery.

How successful is pituitary tumor surgery?

According to the ACS, when transsphenoidal surgery is performed by an experienced neurosurgeon and the tumor is small, the cure rate for cancerous tumors is greater than 80 percent. The chance of a successful outcome becomes much lower if the cancer grows into nearby nerves, brain tissue, or the tissue covering your brain.

A small 2016 study found similar outcomes for tumors resected with craniotomy or transsphenoidal surgery, except with more cerebrospinal fluid leaks in the transsphenoidal surgery group.

Is hormone replacement needed following the surgery?

Hormone replacement therapy is needed if your pituitary gland does not make enough hormones, which is fairly common. The hormones you need to take depend on where the damage is.

Hormone replacement is often temporary but can be permanent. For example, Massachusetts General Hospital says cortisol levels tend to recover after 6 to 18 months. But they may never return to their typical level in some people.

How much does this surgery cost?

A small 2018 study found that the inpatient cost of transsphenoidal surgery was $22,853 and $19,736 when performed through an endoscope.

In a 2016 study, researchers estimated that the median charges per day ranged from $8,485 to $13,321 in New York state.

If you have health insurance, some or most of these costs will be covered. Talk with your insurance provider to find out what your out-of-pocket expenses may be.

Are there alternatives to surgery?

According to the University of Virginia School of Medicine, in more than 90 percent of people with pituitary tumors that produce the hormone prolactin, medication alone can shrink the cancer. Other types of tumors are best removed with surgery.

Pituitary tumor surgery is the primary treatment for tumors in your pituitary gland. Most of these tumors aren’t cancerous, but they can cause your body to over- or underproduce hormones that affect many aspects of your health.

Pituitary tumor surgery has high rates of success when performed by an experienced surgeon. Your surgeon can best advise you about what to expect during and after your procedure.