The pituitary gland, located within the skull, connects to the hypothalamus and links brain activity with hormone production to help maintain the function of organs throughout the body. Considered the master gland of hormone production, the pituitary regulates all other glands within the body.
Pituitary tumors are abnormal growths that develop within the gland and may affect hormone production throughout the body, causing some of the following symptoms:
- Vision loss
- Nausea and vomiting
- Low blood pressure
- Weight gain or loss
The cause of pituitary gland tumors is unknown, although some cases do run in families. Although usually noncancerous, these tumors require thorough treatment to ensure proper pituitary gland function.
Surgery for pituitary gland tumors is the most common form of treatment, and involves removing the entire tumor through either the nose or the top of the skull, depending on the size and location of the tumor. Utilizing advanced surgical techniques such as endoscopy and image guidance, these procedures can be performed effectively with shorter recoveries, less scarring and a lower risk of complications.
Transsphenoidal Surgery for Tumors
The transsphenoidal approach is most frequently taken for the removal of pituitary gland tumors. This technique involves Dr. Lipani accessing the region through the nose to guide the instruments to the pituitary gland, which is found at the bottom of the skull. The name transsphenoidal is used because the surgeon is crossing the sphenoid sinus that is located at the back of the nose.
Transsphenoidal surgery can be performed as an open procedure, with the surgeon making an incision in the nose or under the lip within the mouth. In many cases, it can also be performed endoscopically, using specialized surgical tools with magnification that can be guided through the nostrils. This minimally invasive method is conducted without the need for any incisions. When an endoscopic procedure is used, a CT or MRI scan will be taken in advance to produce a three-dimensional image of your nasal passages, sinus cavity and pituitary gland.
After the patient has been given general anesthesia, transsphenoidal surgery involves creating a hole in the bone behind the nose leading into the skull. This allows Dr. Lipani to reach the pituitary gland, section the tumor into pieces and remove it. The area will then be examined for any further signs of tumor that may be hidden behind nearby tissue. Sometimes, a small amount of fat will be removed from another part of the patient’s body, such as the abdomen, to be used as a filler for the space that develops once the tumor has been removed. The portion of the skull bone that was cut to access the pituitary gland will be supported by either a graft of bone taken from the septum or the attachment of a synthetic mesh. The graft also works to help prevent cerebrospinal fluid from leaking.
In most cases, the entire tumor can safely and successfully be removed. However, on occasion the tumor will be growing in close proximity to a nerve or major blood vessel. Partial removal may be safer in these instances than complete removal so as not to risk damaging healthy tissue that could cause a loss of function.
Recovery from Transsphenoidal Surgery
After surgery, patients will likely stay in the hospital for one to two days before returning home. Many patients experience mild discomfort due to a headache, nausea and nasal congestion for a few days after surgery. These symptoms can be well managed with medications. It is important to avoid blowing your nose, sneezing, coughing and drinking through a straw for approximately four weeks following the procedure.
Dr. Lipani will provide detailed pre- and post-operative instructions to ensure that you achieve successful results from your procedure.
Risks of Transsphenoidal Surgery
Transsphenoidal surgery for the removal of tumors is considered a safe procedure, but all forms of surgery carry some risk. The complications that are associated with transsphenoidal surgery include bleeding, infection, pituitary gland damage, cerebrospinal fluid leakage, vision loss and, very rarely, stroke. Choosing a surgeon experienced in performing this procedure can help lower the risk of developing a complication.