A B C D E F G H I J K L M N O P R S T U V W

PITUITARY SURGERY

Why is Pituitary Surgery performed ?

The pituitary gland lies in the middle of the head, behind the root of the nose and below the brain. Although small (about the size of a pea), it is very important. It controls the release of the body's hormones. These are chemicals which ensure normal bodily function. Any imbalance in production of these hormones can have serious effects. Tumours of the pituitary gland, although rarely cancerous, are important: they can lead to overproduction or underproduction of one or more hormones. If they grow large enough they can affect vision by stretching the nerves to the eyes (the optic nerves) which lie near the gland. The decision to operate and remove a tumour of the gland will usually be taken jointly by an endocrinologist (hormone specialist) and a neurosurgeon, although an eye or ENT specialist may be involved. An operation must be performed if the size of the gland is threatening eyesight or if there is no other way of controlling the hormone abnormality caused by the tumour.

Preparations needed for Pituitary Surgery

Patients having pituitary surgery are usually under the care of an endocrinologist who will have extensively investigated them with blood tests and special brain scans before making a decision to refer them to a neurosurgeon. Many, if not all, of these tests can be done on an outpatient basis and you will probably only need to be admitted to the hospital for the operation itself. The only other test which may be needed is an angiogram. This is a test to show the surgeon how close the major arteries of the brain are to the pituitary gland. If required, it may be done under local or general anaesthetic, depending on the individual surgeon. It is important before this operation to tell the surgeon about any past major illnesses or drugs being taken, and any allergy to iodine.

What Happens during Pituitary Surgery

The pituitary gland can be approached from above or below the pituitary. From above, the operation is called trans-cranial hypophysectomy and is a major procedure involving opening the skull, gently lifting up the brain to expose the gland, and removing the tumour. This procedure tends only to be done nowadays when the tumour is large and stretching the optic nerves (craniotomy). The alternative is to approach the gland from below, as only a thin plate of bone lies between the back of the nose and the gland. This procedure is called a trans-sphenoidal or trans-ethmoidal hypophysectomy . Although it still needs to be performed under general anaesthetic, it is a simpler procedure than trans-cranial surgery. It is performed for the smaller (more usual) tumours. The surgeon will go up through the nose to the base of the skull. The precise route will depend on the individual surgeon. There may be a small scar on the upper gum or side of the nose, or no scar at all if the approach is through the nostril. Once through the base of the skull into the gland, the tumour is identified and removed. After ensuring that there is no bleeding, the hole in the skull base is closed, sometimes with muscle taken from the thigh through a one inch incision, and the nose packed with gauze.

Possible Complications during Pituitary Surgery

All operations carry risks, and operations on the brain carry more than most. The trans-sphenoidal method, however, is usually a safe procedure. The main risk is of bleeding after the operation which may require a return to the operating theatre to stop it. The risks of operation will be explained to you in full by the surgeon.

After Pituitary Surgery

After the operation, recovery is usually rapid. You will probably be sitting out of bed on the next day and able to leave the hospital within a week. Packs in the nose are removed about two days after the operation. There may be a runny nose for a few days, but usually no worse than a mild cold. Tablets are given to replace vital hormones for a few weeks after the operation. Tests will be done by the endocrinologist to see if these tablets can be stopped or if they need to be taken indefinitely, and decisions will be made whether any further treatment such as radiotherapy is needed. After leaving the hospital, take it easy at home for a couple of weeks before thinking of returning to work. If a trans-cranial hypophysectomy has been performed, you should not drive because of the very small risk of an epileptic fit, and should report the operation to the DVLC, who will probably suspend your driving licence for one year. This will not apply for a trans-sphenoidal operation.

If Pituitary Surgery is not performed

This would depend on why the operation was suggested. If it was advised because the eyesight was threatened, blindness may well occur if it is not performed. If it was advised by an endocrinologist for control of hormone imbalance, then another method of controlling the imbalance would need to be found, using either drugs or radiotherapy.

Effects on Family of Pituitary Surgery

Particularly if you are elderly, any replacement hormones required after pituitary surgery may appear confusing. The support of family and friends is then valuable, to ensure correct and regular dosage.