Transsphenoidal Surgery Effective
In Treatment Of Pituitary Tumors
Originally published Spring 2002
Using the transsphenoidal route (through the nose and across the sphenoid sinus of the face), results in no noticeable facial scar.

In the United States, pituitary tumors represent 10% to 15% of all intracranial tumors diagnosed each year. These benign lesions originate from the cells of the pituitary gland, which is located in the sella turcica, a rounded, bony structure behind the nose and ethmoid sinus of the face. A normal pituitary gland serves the vital function of producing hormones that interact with other parts of the body, such as the thyroid and adrenal glands, to regulate hormonal output. Pituitary tumors can disrupt the output of hormones and are broadly categorized as either secreting or nonsecreting tumors.

Types of Pituitary Tumors
Secreting tumors cause excess hormone production. The most common type of secreting tumor is the prolactin tumor. In females, this tumor produces a classic combination of amenorrhea (infertility) and galactorrhea (lactating breasts). These symptoms usually cause women to seek medical attention early, so the tumor is often detected while it is still small. Prolactin tumors are less common in males, and are not usually detected until the tumors are larger in size. This is because men tend to ignore the hormonal symptoms which occur as a result of the tumor, including fatigue and lack of sexual interest.

Many prolactin pituitary tumors can be treated with medicines (Parlodel or Cabergoline), which are suppressive of the prolactin cells. These medicines are normally well tolerated but do not cure the patients and must be taken for life. Patients with larger tumors that cause visual impairment due to compression of the optic chiasm, or those intolerant of treatment with medications, often find that surgery is a viable treatment option. Cure rates for surgery patients are directly related to preoperative prolactin levels.

Other secreting tumors include the Growth Hormone and the Adrenocorticotropic Hormone (ACTH) types. These tumors stimulate excessive adrenal function and can cause drastic medical issues such as hypertension and diabetes. Most of these tumors are treated surgically, although adjunctive treatment with medication or radiation may be necessary for some in the postoperative period.

Nonsecreting (nonfunctional) tumors are usually large when they are discovered due to the lack of hormonal side effects. People with these tumors don’t realize there is a problem until the tumor begins to compress the optic chiasm, causing visual loss. Patients with nonsecreting tumors usually respond well to surgical treatment, though improvement in visual function is dependent on the length of time vision is impaired prior to the procedure.

Surgical Treatment
For the majority of pituitary tumors, surgical care does not require a craniotomy. Instead, the preferred approach involves a transsphenoidal route (through the nose and across the sphenoid sinus of the face), resulting in no noticeable facial scar. The surgery involves some moderate facial discomfort, but is extremely well tolerated. Best of all, the entire process usually requires only a few days of hospitalization for the patient. “Typically, the surgical team for this procedure includes an ENT specialist for the approach, a neurosurgeon for the tumor removal, and an anesthesiologist for general anesthesia,” said practice neurosurgeon Hunter Dyer, M.D.

Dr. Dyer completed a fellowship in pituitary and skull base surgery at L’Hospital Foch, Surenes, in Paris from 1992 to 1993. During this training he participated in over 100 pituitary surgeries and authored two papers on pituitary tumors. In Charlotte, Dr. Dyer has operated on over 225 pituitary lesions since 1994.

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