Surgery for Pituitary Tumors

The main treatment for many pituitary tumors is surgery. How well the surgery works depends on the type of tumor, its exact location, its size, and whether it has spread into nearby structures.

Transsphenoidal surgery

This is the most common way to remove pituitary tumors. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. The back wall of the sinus covers the pituitary gland.

illustration showing the location of the pituitary and includes a detail of the posterior and anterior pituitary in relation to the hypothalamus, sella turcica and sphenoid sinus

To do this surgery, the neurosurgeon makes a small incision (cut) along the nasal septum (the cartilage between the 2 sides of the nose) or under the upper lip (above the teeth). To reach the pituitary, the surgeon opens the boney walls of the sphenoid sinus with small surgical chisels, drills, or other instruments depending on the thickness of the bone and sinus. Small tools and a microscope are used to remove the tumor.

Another approach is to use an endoscope, a thin fiber-optic tube with a tiny camera at the tip. This way, the incision under the upper lip or along the nasal septum isn't needed, because the endoscope allows the surgeon to see through a small incision that's made in the back of the nasal septum. The surgeon passes instruments through the nose and opens the sphenoid sinus to reach the pituitary gland and take out the tumor. Whether this technique can be used depends on the tumor’s position and the shape of the sphenoid sinus.

The transsphenoidal approach has many advantages. First, no part of the brain is touched during the surgery, so the chance of damaging the brain is very low. There may be fewer side effects, and there's also no visible scar. But this surgery may take longer, and it’s hard to take out large tumors this way.

When this surgery is done by an experienced neurosurgeon and the tumor is small (a microadenoma), the cure rates are high (greater than 80%). If the tumor is large or has grown into the nearby structures (such as nerves, brain tissue, or the tissues covering the brain) the chances for a cure are lower and the chance of damaging nearby brain tissue, nerves, and blood vessels is higher.

Craniotomy

For larger or more complicated pituitary tumors, a craniotomy may be needed. In this approach the surgeon operates through an opening in the front of the skull, off to one side. The surgeon has to work carefully beneath and between the lobes of the brain to reach the tumor. Craniotomy has a higher chance of brain injury and other side effects than transsphenoidal surgery for small lesions, but it’s actually safer for large and complex lesions because the surgeon is better able to see and reach the tumor as well as nearby nerves and blood vessels.

Planning surgery

For both transsphenoidal surgery and craniotomies, the doctor may use image-guidance with MRI or CT scans before surgery to learn as much as they can about the tumor. It's important to know how big the tumor is and whether it has spread beyond the pituitary gland to plan the best surgical approach and predict how likely it is that they will be able to take out all of the tumor.

In rare cases, both types of surgery are used at the same time to try to completely remove large tumors that have spread into nearby tissues.

As a general rule, smaller pituitary tumors are easier to treat with surgery. The larger and more invasive the tumor, the less likely the tumor can be cured by surgery. Side effects also tend to be more likely after surgery to remove large, invasive tumors.

Possible side effects of surgery

Surgery on the pituitary gland is a serious operation, and surgeons are very careful to try to limit any problems either during or after surgery. Complications during or after surgery such as bleeding, infections, or reactions to anesthesia (the drugs used to make you sleep during surgery) are rare, but they can happen.

Most people who have transsphenoidal surgery will have a sinus headache and congestion for up to a week or 2 after surgery.

If surgery causes damage to large arteries, to nearby brain tissue, or to nerves near the pituitary, it can lead to brain damage, a stroke, or blindness, but this is quite rare.

When doctors use the transsphenoidal approach to operate on the pituitary gland, they create a temporary pathway between the nasal sinuses and airways and the brain. Until this heals, a person can get meningitis, infection and inflammation of the meninges (the thin protective layers covering the brain). Damage to the meninges can also lead to leakage of cerebrospinal fluid (CSF, the fluid that bathes and cushions the brain) out of the nose. Whether this happens seems to depend to the size and type of tumor.

Diabetes insipidus (see Signs and Symptoms of Pituitary Tumors) may occur right after surgery, but it usually improves on its own within a few weeks after surgery.

Damage to the rest of the pituitary can lead to other symptoms from a lack of pituitary hormones. This is rare after surgery for small tumors, but it may be unavoidable when treating some larger macroadenomas. If pituitary hormone levels are low after surgery, this can be treated with medicine to replace certain hormones normally made by the pituitary and other glands.

You will be closely watched and your blood will be checked often as your body adjusts to normal hormone levels. If diabetes insipidus doesn't get better, it may need to be treated with a desmopressin nasal spray. If vitamin and/or mineral levels change, you may need supplements for a while. For instance, potassium levels often drop, so you may need to get it intravenously (IV, or in a vein) right after surgery.

Complications are rare after pituitary surgery, but they can be serious. Talk to your doctor about what you should watch for and what you should do if you have any problems.

For more general information about surgery as a treatment for tumors, see Cancer Surgery.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Alzhrani G, Sivakumar W, Park MS, Taussky P, Couldwell WT. Delayed Complications After Transsphenoidal Surgery for Pituitary Adenomas. World Neurosurg. 2017; Oct 5.

Graillon T, Castinetti F, Fuentes S, et al. Transcranial approach in giant pituitary adenomas: results and outcome in a modern series. J Neurosurg Sci. 2017 Jan 12.

Guo-Dong H, Tao J, Ji-Hu Y, et al. Endoscopic Versus Microscopic Transsphenoidal Surgery for Pituitary Tumors. J Craniofac Surg. 2016;27(7):e648-e655.

Han S, Gao W, Jing Z, Wang Y, Wu A. How to deal with giant pituitary adenomas: transsphenoidal or transcranial, simultaneous or two-staged? J Neurooncol. 2017;132(2):313-321.

Han Y, Jiang ZQ, Zheng XL, et al. Curative effect analysis of two surgical methods for removal of pituitary adenoma via endonasal transsphenoidal approach. Zhonghua Yi Xue Za Zhi. 2017;97(19):1479-1483.

Kuo JS, Barkhoudarian G, Farrell CJ, et al. Congress of Neurological Surgeons (CNS) and the AANS/CNS Tumor Section.  Guidelines Management Patients Non Functioning Pituitary Adenomas. Surgical Techniques and Technologies for the Management of Patients with Nonfunctioning Pituitary Adenomas. 2016. Accessed at www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6 on October 13, 2017.

Li A, Liu W, Cao P, et al. Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis. World Neurosurg. 2017;101:236-246.

Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab. 2017;8(3):33-48.

Sanmillán JL, Torres-Diaz A, Sanchez-Fernández JJ, et al. Radiological Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-center study. World Neurosurg. 2017 Sep 9.

You L, Li W, Chen T, et al. A retrospective analysis of postoperative hypokalemia in pituitary adenomas after transsphenoidal surgery. PeerJ. 2017;5:e3337.

Zhou Q, Yang Z, Wang X, et al. Risk Factors and Management of Intraoperative Cerebrospinal Fluid Leaks in Endoscopic Treatment of Pituitary Adenoma: Analysis of 492 Patients. World Neurosurg. 2017;101:390-395.

Last Medical Review: November 2, 2017 Last Revised: November 2, 2017

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.