What Are Pituitary Tumors?
Pituitary tumors grow from the pituitary gland located deep in the skull. These tumors can affect the whole body by interfering with hormone production. As the tumor grows, it can cause a variety of symptoms including vision problems.
A tumor that grows from the pituitary gland is called an adenoma. Adenomas most often arise in the anterior lobe of the pituitary gland. Tumors of the pituitary gland occur in 15 to 20% of adults and are classified as functional or nonfunctional.
Functional tumors secrete abnormal levels of hormones and interfere with the normal hormone regulation process. These tumors behave according to their cell of origin and are named for the specific hormone they produce. For example, if a tumor originates in a prolactin-producing cell, you may develop a prolactin-secreting pituitary tumor.
Nonfunctional tumors do not secrete hormones. Instead, they grow until their size and mass effect cause headache, vision loss, nausea, vomiting, or fatigue. Based on size, pituitary tumors can be either microadenomas (less than 10mm) or macroadenomas (larger than 10mm). Large tumors can press on the optic nerves and invade the cavernous sinuses, which house the carotid arteries and the nerves involved in eye movement.
Surgical treatment aim to remove the tumor or control its growth and restore normal hormone function.
A skin incision is made in the forehead or eyebrow. A small bone flap above the eye (supraorbital craniotomy) is cut and removed to access the brain.
ENDOSCOPIC PITUITARY SURGERY
Neurosurgeons and ear, nose and throat surgeons (Otolaryngologists) combine to remove these tumors by approaching them through the nose or the roof of the mouth. Endoscopic Surgery is performed through the nose to remove tumors from the pituitary gland and deep areas of the skull base.
Pituitary tumors can cause hormone problems and grow to large size causing vision loss. Tumor removal often reverses vision problems and restores hormone balance.
No surgery is without risk. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to a craniotomy may include stroke, seizures, venous sinus occlusion, swelling of the brain, and CSF leakage.
Risks related to acoustic neuroma surgery may include:
Facial weakness is the loss of muscle control on one side of the face caused by nerve swelling or damage; it may be temporary or permanent. Temporary facial paralysis or weakness is common after surgery and may persist for 6 to 12 months. Those with facial weakness will need to take extra care of their eye with artificial tears and lubricant until facial nerve function improves. Facial nerve function is directly related to the size of the tumor.
Eye problems may occur as the result of facial weakness or paralysis that prevents the eye from closing completely. This allows the eye to become dry and unprotected. Artificial tears, eye lubricants, protective glasses, bandage contact lenses, and taping the eye shut are all options to protect the cornea.
Hearing loss is the most common complication and may be permanent in the affected ear because the tumor is wrapped around the cochlear nerve. In small tumors it is possible to save hearing when removing the tumor. Larger tumors usually have already caused some hearing loss or deafness prior to surgery.
Balance problems are common and generally improve after surgery with head exercises, Pilates, or Tai Chi. Care should be taken when using stairs or escalators. Persistent balance or dizziness problems may need treatment with vestibular (balance) rehabilitation.
Cerebrospinal fluid (CSF) leakage is the escape of CSF that flows around the brain.
Headache is common after acoustic neuroma surgery and usually subsides within several weeks. Persistent headache (>3 months) can occur after suboccipital craniotomy.