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Pituitary gland surgery may be necessary to treat a tumor or cyst arising from the pituitary gland. In many cases, pituitary gland surgery is carried out using what is known as the transsphenoidal approach. This means that the surgeon reaches the gland through a cavity at the back of the nose, known as the sphenoidal sinus. The operation is carried out through a small opening, so special visualizing instruments may be used, known as an endoscope and a high powered microscope. Tumors are usually cut into smaller pieces before their removal.
The pituitary, or hypophysis, is an endocrine gland located under the hypothalamus in the brain. Sometimes a growth, such as a pituitary adenoma, will develop from the gland. Although these tumors are usually benign, or non-cancerous, some may produce hormones which give rise to symptoms. Others may grow quite large, leading to pituitary gland damage, or they may cause problems by pressing on surrounding tissues. In all these cases, surgery may be required to relieve symptoms.
Before pituitary gland surgery is carried out, it is important for patients to practice breathing through their mouths. This is because the nostrils will remain blocked for a period of time following the operation. Food and drink are not allowed on the evening before surgery.
Pituitary gland surgery is performed using a general anesthetic, which means that the patient is unconscious during the procedure. A cut may be made in the back of the nose to gain access to the sphenoid sinus. Alternatively, an incision might be made under the upper lip, following the line of the gum, to reach the nasal cavity and sinus. An advantage of these techniques is that the patient has no visible scar after surgery.
After reaching the pituitary, the surgeon removes the tumor from the center outward. The operation may take around three hours and, sometimes, it is not possible to remove all of the tumor. This could be because the whole tumor is not visible, or it is too close to important blood vessels and nerves. Possible complications include bleeding, infection, fluid leaking from around the brain, and, most commonly, pituitary damage leading to hormone deficiencies.
Following the surgery, pieces of tissue are used to seal holes and prevent leaks from the pituitary chamber and the sphenoid sinus. The incision is sewn up and the nostrils are filled with packing material, which remains in place for up to three days. Patients should try not to bend over or sneeze and a special, soft toothbrush must be used.