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Pituitary Surgery
Pituitary Surgery is a surgical procedure that involves the removal of a lesion within the pituitary gland, a small, pea-sized gland situated at the base of the brain.
Have you been experiencing persistent symptoms that are affecting your quality of life? Consult our senior consultant neurosurgeon today for an accurate diagnosis & personalised treatment plan.
Dr Keith Goh
What Is Pituitary Surgery?
This is a surgical procedure that involves the removal of a lesion within the pituitary gland, a small, pea-sized gland situated at the base of the brain. The surgery aims to treat disorders such as pituitary tumours or other abnormal growths that affect the gland’s function.
What Is The Pituitary Gland?
The pituitary gland, often referred to as the “master gland”, is situated behind the bridge of the nose, at the base of the skull. It is part of the endocrine system, responsible for producing and releasing hormones that regulate various bodily functions. This gland has two main parts: the anterior (front) lobe and the posterior (back) lobe.
The anterior lobe produces hormones that influence growth, metabolism, and reproduction. The posterior lobe releases hormones which regulate kidney function and uterine contractions during childbirth.
Indications for Pituitary Surgery
This is usually indicated for patients with pituitary tumours, known as adenomas. These tumours can be either functioning, producing excess hormones, or non-functioning, not producing hormones. Depending on their size and activity, they may cause symptoms like vision problems, hormonal imbalances, and headaches.
Other conditions that may necessitate surgery include:
- Cushing’s Disease: This disease is caused by a pituitary tumour leading to the overproduction of cortisol, resulting in symptoms like weight gain, thin skin, and high blood pressure.
- Acromegaly: Acromegaly results from excess growth hormone production, leading to enlarged hands and feet, facial changes, and various systemic complications.
- Prolactinoma: Prolactinoma involves a tumour causing high levels of prolactin, potentially leading to infertility, changes in menstrual cycles in women and decreased libido in men.
- Craniopharyngiomas: These are benign tumours, found near the location of the pituitary gland at the anterior skull base. They may impact pituitary function and affect vision, especially because they can grow to a large size.
- Hormone-Secreting Tumours: Pituitary surgery may be necessary in certain cases where medical management of hormone-secreting tumours is ineffective or not feasible.
Types of
Pituitary Procedures
There are three main surgical approaches, each chosen based on the tumour’s size, anatomical features, and the patient’s overall health.
- Transsphenoidal transnasal surgery: This is the most common approach, where the surgeon uses an endoscope to access the pituitary gland through the nose and sphenoid sinus, minimizing brain disturbance. It is typically used for tumours less than 10 mm in size, but with specialized image guidance technology, even larger lesions can be treated.
- Open Craniotomy: It is used for large tumours or those extending beyond the pituitary region and affecting the optic nerves – this approach involves opening the skull to access the gland.
- Stereotactic Radiosurgery: This method uses focused radiation to target and destroy tumour cells. It is an option for patients who cannot undergo surgery or have residual tumours after surgery.
Preparing For Pituitary Surgery
This involves several steps to ensure the patient is ready for the procedure both physically and mentally.
- Hormonal Evaluation: Since the pituitary gland influences several hormonal pathways, preoperative hormonal tests are critical to understand the baseline levels and anticipate postoperative hormonal imbalances.
- Neurological and Vision Assessment: Given the close proximity of the pituitary gland to optic nerves, a detailed neurological and vision examination is necessary to evaluate any existing impairments and to plan surgery accordingly.
- Radiological Imaging: MRI or CT scans are used to determine the exact size, location, and extent of the pituitary tumour.
- Medication Adjustment: Some medications may need to be adjusted or stopped before surgery, particularly blood thinners, to reduce the risk of bleeding.
Transsphenoidal Surgery Procedure
Safe and effective, Transsphenoidal Pituitary surgery is often the procedure of choice for many patients, and follow these steps:
- Anesthesia: The patient is placed under general anaesthesia to ensure they are unconscious and pain-free during the surgery.
- Incision and Access: An incision is usually not necessary. The Endoscope is inserted into the nostril and directed upwards to the sella, i.e. the skull base area in which the pituitary gland is located.
- Tumour Removal and Endoscopy: Using the Endoscope and specialized Microsurgical tools, the surgeon removes the lesion or abnormal growth from the pituitary gland. An Operating Microscope is sometimes needed in complex cases.
- Closing the incision: After the tumour is removed, the incision site is closed using biocompatible material. A piece of fat or muscle is often used to fill the space and prevent cerebrospinal fluid leaks.
Recovery and Rehabilitation
Immediate postoperative monitoring includes vital signs, neurological status, and fluid balance. Close observation is necessary to detect any signs of complications, such as bleeding, infection, or cerebrospinal fluid leak. Often, there are hormonal imbalances which result in excessive urine output.
Afterwards, long-term management and follow-up are crucial for monitoring the patient’s recovery and adjusting treatment as needed. These include:
- Regular hormonal assessments: These assessments are key to managing any imbalances and help doctors adjust hormone replacement therapy as required.
- Neurological evaluations: Long-term effects of the surgery on brain function can be detected, and quickly resolved.
- Regular eye exams: Regular eye exams are important to monitor any changes in vision and address any issues that arise promptly.
- MRI Scans: Periodic MRI scans are recommended to check for any recurrence of the tumour.
Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
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Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
Frequently Asked Questions (FAQ)
How long does recovery take?
Generally, hospital stays may last from a few days to a week, and complete recovery can take several weeks to months.
Will I need hormone replacement therapy after surgery?
Due to the pituitary gland’s role in hormone production, patients may require lifelong hormone replacement therapy following pituitary surgery. Consult your neurosurgeon or a qualified specialist on potential hormone replacement therapy required after your procedure.
What are the signs of complications I should watch out for after surgery?
Symptoms to watch for include persistent headaches, poor vision, excessive thirst and urination, nerve paralysis, nausea, fever, and any signs of infection or bleeding. Immediate medical attention should be sought if these occur.
Is surgery a cure for pituitary tumours?
Most pituitary tumours can be treated surgically, and symptoms will be alleviated, but it’s not always a cure. Some tumours may recur, requiring additional treatment, such as radiation. Engage your neurosurgeon to further discuss the possibility of recurring tumours and additional treatment options.