When does one need surgery? | Pituitary tumor

When does one need surgery?

The diagnosis of a pituitary tumor does not always require surgical treatment. In the case of particularly small tumors (so-called microadenomas), for example, regular follow-up examinations may be sufficient. Surgical removal (resection) of the tumor becomes necessary, especially when symptoms occur.

The urgency of the operation depends on the symptoms caused by the tumor. In the case of visual field failures or severe hormone deficiency symptoms, surgical removal of the tumor is usually the only possibility of cure. In rare cases, complete resection is not possible.

As a consequence, regular check-ups or a new operation are necessary. In the case of non-operable tumors, radiotherapy represents an alternative to surgical resection. Adenomas usually show a good response to radiotherapy.

An exception is the most common prolactinoma. As a rule, this can also be treated with medication. By administering dopamine agonists (e.g. bromocriptine), the growth of a prolactinoma can be slowed down and the symptoms alleviated.

The duration of surgical removal of a pituitary tumor depends on the location of the tumor and the type of surgical procedure. While an endoscopic operation via the nose (transphenoidal) usually takes no more than 1-2 hours, an operation with opening of the skull (transcranial) can take several hours. Normally, no intensive treatment is necessary following the surgical removal of the pituitary tumor.

There are two different surgical procedures depending on the access route. The procedure of choice is the transphenoidal approach. This is used today in about 90% of cases.

The operation is performed with the help of an endoscope through the nose. Through the opening of the sphenoid cavity at the back of the nasal cavity, the pituitary gland is accessed. In case of very large tumors, the opening of the skullcap is necessary (transcranial access). This procedure is used today in only about 10% of cases. After the skull is opened, the pituitary gland is located at the bottom of the brain.