Pituitary Tumor Surgery:
Transsphenoidal Surgery

What Is It and What Is It Used For?

Pituitary tumor surgery is the most common treatment for tumors of the pituitary gland, the most common by far being the pituitary adenoma, a benign tumor of the anterior pituitary gland.

Most pituitary adenomas are benign and many of them can thus be controlled or cured by surgical removal of the tumor while preserving the normal gland as much as possible. There are a few exceptions to the rule that surgery is the primary treatment. In particular, for very small and asymptomatic tumors simply watching and waiting may be recommended. For some specific types of pituitary adenoma, most notably prolactinomas, other medical treatments (dopamine agonist medications) may often be tried as the first line treatment before considering surgery.

The pituitary gland is almost directly in the middle of the head, just below the base of the brain. For this reason, it can be a bit tricky to get to surgically except by one route. Transsphenoidal surgery is the name for the most common type of surgical procedure which is used to approach the area of the pituitary gland. This approach uses the nose and nasal passages to reach the sella turcica, the part of the skull bone in which the pituitary gland sits. It is called transsphenoidal because at the back of the nasal canal there is a sinus (an air filled chamber in the bone) just in front of and below the pituitary gland called the sphenoid sinus (named because it sits in the sphenoid bone).

In transphenoidal surgery, the surgeon uses the nasal passages to reach the sphenoid sinus which is then opened to gain access to the bone of the sella turcica which is protecting the pituitary. Once through that bone, the surgeon can carefully remove the pituitary tumor through this route. This type of procedure is typically done by a neurosurgeon (brain surgeon) although in some centers they are assisted by others such as an ENT.

There are a few different ways to perform pituitary tumor surgery through the transsphenoidal route. One option is the type of visualization the surgeon uses. The route through the nasal passages to the pituitary is a long one and thus advanced lighting and magnification are required. While traditionally this was done with a surgical microscope, more and more surgeons are moving to endoscopic techniques which utilize a long scope, called an endoscope, which allows the surgeon to see the surgical field close up on a video monitor. There are advantages to both visualization techniques and different surgeons have different preferences when considering use of the microscope versus an endoscope.

In addition to the type of visualization used in pituitary tumor surgery, the route through the nasal canal is also variable. When it was first being used clinically, the transsphenoidal approach used to be done through an incision under the upper lip which allowed the surgeon to tunnel up the nasal septum to the sphenoid sinus. However, because of the relative invasiveness of this approach most modern surgeons prefer other routes. The most common route now is the endonasal route, which advances directly through the nostril and up through the nasal cavity. The only surgical opening is at the back end of the nasal cavities, just in front of the sphenoid sinus. Most surgeons, whether using microscopic or endoscopic technique, agree that this approach is the least traumatic to the tissues and results in easier and faster recovery.

Generally, transsphenoidal surgery is well tolerated by patients and recovery time and rate of complications is less than for more invasive types of approaches to the brain and its surrounding structures. As mentioned above, the specifics of the approach can vary depending on surgeon preference. If you have questions about your own pituitary tumor surgery, discuss them with your own treating neurosurgeon.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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