surgery for pituitary tumor is performed to remove/partially
remove a benign tumor from within the pituitary gland.
The patient will
be taken to the operating room and put to sleep under general
anesthesia. The surgeon may elect to have a lumbar drain
placed. This is a tube placed within the spinal canal
in the low back, and permits crainage of spinal fluid or instillation
of air within the spinal canal, which may help the surgeon
to perform the surgery. The head is often placed in
three fixation points (Mayfield head pins). The surgeon
may register a navigational device which allows the use of
"real time" intraoperative navigation.
A portion of the outer mid thigh is usually exposed to allow
the surgeon to take a small tissue graft. An ENT (ear,
nose, throat surgeon) surgeon or the neurosurgeon will make
the approach through the upper gum area within the mouth,
traversing the deep nasal cavity and sphenoid sinus (a cavity
filled with air and mucous membranes, just in front of the
pituitary gland: therefore the term transsphenoidal
to describe the route of the surgery), to get to the base
of the skull where the pituitary gland lies. The neurosurgeon
will then open the floor of the sella (cavity in the skull
base where the pituitary gland lies). Next the dura
(firm tissue lining the sella) will be opened, and the pituitary
gland will be seen. If the tumor is large, the surgeon
will immediately see it, but if it is small and buried deeply
within the gland, the surgeon will need to open the gland
and look for it. After removing as much of the tumor
as possible, the surgeon will achieve hemostasis (stop the
bleeding), and may place a graft of fat or fascia lata (firm
tissue harvested from the thigh), and place it within the
sella and sphenoid sinus. The nasal cavities and gums
will then be closed.
Risks for craniotomy
for acoustic neuroma can be broken down into two categories,
1) those related to the operative site, and 2) those related
to the risks of anesthesia.
Risks related to the operative site
Exposure: The patient is placed lying on their
back so as to allow good access to the nasal passages and
tumor. There is risk of non healing of
the gums through which the incision is made, post
operatively. Although very uncommon, there can be
injury to or tearing of the scalp from the pins on the Mayfield
clamp. There is the potential for spinal fluid leak
postoperatively, which may require additional surgery or
placement of a lumbar drain to repair.
The surgery involves opening the nasal passages to expose
the tumor. There can be infection from the oral and
nasal cavities. The pituitary gland is located in
a very small space. Above it is the optic chiasm (nerves
to the eyes), and next to it on either side is the cavernous
sinus (a large vein) which contains the carotid artery (a
critical artery supplying blood to one hemisphere of the
brain) and cranial nerves III, IV, and VI (these nerves
supply facial sensation and eye movement). Behind the pituitary
gland is the brainstem and basilar artery (critical artery
supplying the brainstem and rear portions of the brain).
Certainly these structures are at risk, and although damage
to them is not likely, if it does occur, the consequences
may be devastating, with resulting blindness, paralysis
and death. In addition, if there is brain injury,
this could result in weakness, seizures, stroke, paralysis,
coma or death. If a spinal fluid leak occurs, if may
be necessary to have additional surgery, or place a lumbar
drain. There is a possibility of tumor remaining after
surgery, or of recurrence of tumor in the future.
If there has been impairment of vision preoperatively, due
to compression of the optic nerves (nerves going to the
eyes), the vision may not necessarily improve with surgery.
such general difficulties, such as bleeding, infection,
stroke, paralysis, coma and death. Incisions in the
gums generally heal well, but could become tender,
numb, or may heal in an unpleasant manner.
The tumor may recur, requiring additional surgery
or radiation in the future. In addition, although
every attempt is made to protect all areas of the body from
pressure on nerves, skin and bones, injuries to these areas
can occur, particularly with prolonged cases.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given
There may be
some pain and discomfort associated with transsphenoidal surgery.
Your surgeon will prescribe pain medications for any pain
associated with the .
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- Take it easy
until seen by the physician. This does not mean bed
rest, but athletic activities during this period are definitely
not recommended. Please give your incision a chance
to heal. Avoid any type of activity which might risk
a blow to the head.
- You may resume
activity as your body permits, but avoid extremes.
For example, walking is fine, but avoid any strenuous running.
USE GOOD JUDGMENT AND COMMON SENSE. If you have
a question, ask your doctor.
- No driving
until cleared with your surgeon. A driving test may
be required, at the discretion of your surgeon. Even
though you may feel fine, your peripheral vision and reflexes
may have been affected, and we want you to be safe on the
road for yourself as well as for others.
- You may shower
after you go home unless otherwise instructed. Cover
the incision on your thigh with plastic wrap before the
shower and remove it afterward. Change dressing immediately.
You may shower without covering the incision one week after
the staples are out. Follow instructions concerning
care of tapestrips, stitches or staples. Your surgeon
or his nurse clinician will explain the techniques used
in the closure of your incision.
- Sexual activities
- If you notice
swelling, redness or opening of the incision, or if there
is any clear fluid draining from it, please contact your
surgeon immediately! If you develop a fever, stiff
neck or chills, contact the office immediately. Take
your temperature at 4:00 PM daily until the clips are removed.
Call if greater than 101 degrees Fahrenheit.
- If you have
a seizure, notify our office or come to the emergency room.
- If you develop
any new weakness or changes in vision, notify our office.
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
If steroids or hormonal replacements have been prescribed,
make sure to follow directions carefully
- Do not take
any medications which will "thin the blood" such
as coumadin or aspirin, or other non-steroidal antiinflammatory
medications, unless otherwise advised by your physicians.
- Make sure
to follow up with any other physicians involved in your
care. These may include your family physician, neurologist,
endocrinologist and radiation oncologist.