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Brain Education: Pituitary Tumor

The pituitary gland is a small structure attached to the base of the brain behind the nose, where it is protected by a part of the skull called the sphenoid bone. The majority of Pituitary adenomas are benign slow-growing tumors that arise within the pituitary gland. Most pituitary adenomas are microadenomas, or small tumors, although a few patients have macroadenomas, which are larger.

Symptoms

If the adenoma is endocrine-active, it can secrete excessive hormones, causing signs and symptoms of hyper-secretion in addition to the problems such as hydrocephalus or seizures caused by the mass of the tumor itself.

Symptoms associated with hyper-secretion:

• Abnormal nipple discharge
• Absent menstruation (periods)
• Breast development in men
• Low blood pressure
• Sensitivity to heat or cold
• Excessive body hair
• Facial changes

Treatment Options

The treatment options for pituitary adenomas include surgery, drugs and radiotherapy. The transphenoidal route is the most common approach used today using either a endonasal endoscopic approach or transeptal microscopic approach.

Both approaches are carried out under general anesthetic. For endoscopic transphenoidal pituitary adenoma resection, an endoscope is inserted into the nostril towards the base of the tumor at the skull base. Surgical instruments are then inserted next to the endoscope through the same nostril. For transeptal approach, a retractor is inserted underneath the septal mucosa to access the skull base and the tumor is removed under microscope. Then, the bony floor of the space occupied by the pituitary is closed.

The localization of the brain tumor is sometimes aided intraoperatively by a computerized guidance system, requiring preoperative MRI on the morning of surgery for placement of the fiducial markers. The surgery lasts several hours and most people will spend a night in the ICU and an additional couple of days in the hospital.

Laser-assisted tumor removal is the latest technology used in the resection of neural tumors in the brain or the spinal cord. Carbon Dioxide laser is being transmitted via fiberoptics to aid tumor removal. Traditional techniques using microdissection and CUSA (Cavitronic Ultrasonic Suction Aspiration) prove to be ineffective in dense, fibrous, calcified tumor. In large vascular tumor especially, traditional techniques are associated with significant blood loss. The use of laser increases the precision of the resection, improves access to the tumor like in pituitary tumor at the skullbase, decreases blood loss and indirectly leading to a less lengthy surgery.

Learn more about Laser-assisted pituitary tumor removal »