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Pituitary Tumors
Treatment

Transsphenoidal Surgery

Pituitary tumors often can be removed safely through a neurosurgical procedure called transsphenoidal surgery. The word "transsphenoidal" describes the path the surgeon follows to reach the pituitary gland. The word comes from "trans," meaning "to cross or pass through," and "sphenoid," the name of the cavity, the sphenoid sinus, that is passed through to reach the pituitary gland. The operation now can be performed without any facial incision under the lip or in the nose.

The surgeon begins the approach to the pituitary gland by entering the nose on one side. The surgeon uses a very tiny microsurgical instruments especially designed for this particular operation and a brilliant fiberoptic light to illuminate the internal anatomy. In addition, a microscope magnifies the surgical area 12 times its actual size.

The surgeon then guides the instrument into the nasal cavity and an opening is made in the sphenoid bone. Once through the sphenoid sinus, an opening is made in the wall of the sella turcica to expose the pituitary gland.

The tumor can be readily distinguished from the normal pituitary gland tissue and is removed, preserving the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing.

No nasal packing is required after the surgery. Typically, patients go home the following day.

Sometimes it is necessary to place a spinal drain, a tiny tube threaded into the space in the lower back that is occupied by spinal fluid, during surgery. This tube allows the surgeon to remove spinal fluid or inject saline solution into the spinal fluid space. Because the spinal fluid in the lower back mixes with the fluid around the brain and pituitary gland, changes in the level of the fluid in the spinal area can move the pituitary gland in such a way that the surgeon can remove the tumor more easily.

Some patients wake up after the operation with a mild lower back pain, a small bandage on their back and maybe even a drainage bag that will remain in place for 24 hours.

High-Precision Radiosurgery

The Gamma Knife is an advanced radiosurgery treatment used for small- to medium-size tumors, such as pituitary adenomas. It can also treat epilepsy, trigeminal neuralgia and abnormal blood vessel formations located deep in the brain.

Despite its name, it isn't a knife but delivers a single, very finely focused, high dose of radiation precisely to its target, while causing little or no damage to surrounding tissue. Abnormalities measuring 1.5 inches in diameter or smaller — even abnormalities no larger than a small pebble — are treated with the Gamma Knife.

Medications

The goal of medical therapy is to block the tumor from making abnormal quantities of hormones. Specific drugs are used to control specific types of hormone secretion.

The production of prolactin is controlled with the drug bromocriptine, which reduces the size of the tumor while maintaining normal prolactin levels. Bromocriptine also may be used with other treatments as well. Somatostatin analogues, such as Sandostatin, are used in conjunction with surgical removal for growth hormone-secreting tumors. These drugs are also used on recurrent tumors. Mitotane (Lysodren) and ketoconazole (Nozoral) are drugs used for ACTH-secreting tumors.

Reviewed by health care specialists at UCSF Medical Center.