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Pituitary Tumors

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Pituitary Tumors
Everything you need to know

B. Todd Schaeffer, MD, FACS
May 2011

ENT and Allergy Associates, LLP

Macroadenoma

Large tumor, usually non-secreting (hormone levels are normal),
cause headache or visual disturbance.

Microadenoma

Small tumor, usually secretes hormone. Excess Growth Hormone (Acromegaly), excess ACTH (Cushing's Disease) or excess Prolactin (Prolactinoma).

Apoplexy

Sudden onset headache with bleed into pituitary tumor with sudden visual disturbance. Requires emergency surgery.

 

The pituitary gland is pea-sized and is the master gland. It hangs down from the base of the brain. It secrets

ENT nassau county

nine hormones which control several bodily activities. It is strategically located between the carotid arteries and below the optic chiasm. The optic chiasm is where the optic (vision) nerves cross and meet behind the eyes. The pituitary gland sits behind the sphenoid sinus.

The sinus is an air containing space whose upper back wall lies in front of the pituitary gland. Its sidewalls are where the carotid arteries (the major arteries that supply the brain) and optic nerves traverse. About 10% of brain tumors are pituitary tumors. Over 95% of pituitary tumors are benign and are called adenomas. About 85% of tumors involving the pituitary region are benign. Not all pituitary tumors need to be removed. A microadenoma (small tumor) commonly secrete excess hormones, which are dedected by blood tests. A protactinoma can be treated with medicine. However, excess ACTH secreting tumors (Cushing's Disease) which increase cortisol levels or Growth Hormone secreting tumors require surgery because if untreated they are fatal.

Sinus surgery long island

The pituitary gland sits behind the sphenoid sinus, below the optic chiasm and between the carotid arteries at the skull base. The easiest and quickest way to access the gland is by using an endoscope in the nose, which is Dr. Schaeffer's expertise. He does not use packing after surgery so the patient has an easier recovery.

 

 

Sinus surgery nassau

Endoscopic Skull Base

Surgeons. Above Dr Schaeffer providing the approach to skull base tumors through the nose. To the right Neurosurgeon Dr. Mark Eisenberg and sinus surgeon Dr. B. Todd Schaeffer performing 3D Pituitary Surgery for the first time on Long Island, April 2010.

 

 

 

Pituitary tumors are either found on imaging tests such as MRI of the brain or by blood tests demonstrating excess hormones. An eye exam determines if the vision nerves are affected. Typically, peripheral vision is affected first with patients complaining of blurry vision. Double vision and blindness can also be caused by a pituitary tumors depending on size and location of the tumor. An eye exam and visual field test are typically required. Headache is the most common symptom of a pituitary tumor and a MRI of the brain will detect it.

WHAT TO EXPECT: Pituitary surgery is performed endoscopically through the nose while the patient is asleep under general anesthesia. Image guidance (computer navigation) is frequently utilized. The surgery takes about three hours. The patient is transferred to the recovery room (PACU) and spends the evening there or is transferred to the neurosurgical ICU (NSICU) for 24 hours of observation. Monitoring of fluid intake and urine output during the first 24 hours is critical as the natural hormone to regulate fluid balance is located in the pituitary and

Sinus surgery nassau

 

 

may be temporarily functioning improperly. A typical hospital stay is three days.

CHECK LIST OF WHAT TO DO PRIOR TO SURGERY

Must be seen by eye doctor (visual field test), endocrinologist (blood tests), neurosurgeon, sinus surgeon and medical doctor for clearance for surgery.

Nothing to eat or drink after midnight prior to surgery.

Go to CT scan with flducials ("stickies" on forehead) either morning of or day before surgery.

Stop Aspirin, Advil, Motrin, Alleve, Plavix and any blood thinners 10-14 days prior to surgery as directed.

 

 

Why should the pituitary tumor be removed and what are the risks?

ENT Long island

Large pituitary tumor eroding into
sphenoid sinus

 

 

It has been determined that the pituitary tumor (macroadenoma) is growing beyond the region of the pituitary gland (sella) and will potentially if not already affect your vision. It also causes headaches, which medicines are unable to treat or control. The tumor may also impair blood flow to the brain. Acromegaly (Growth Hormone excess) and Cushing's Disease (excess ACTH leading to excess cortisol) have no adequate medical treatment. If left untreated they will be fatal. Surgery is required to remove the entire tumor.

The major risks of any surgery are anesthesia, bleeding or infection. Risks of pituitary surgery also include blurry vision, double vision, the remote possibility of blindness, revision surgery, leakage of brain fluid (CSF leak), meningitis and stroke. While these risks are less than 1%, it has been deemed these risks are outweighed by the benefits of the surgery. In other words, you have more risk by NOT performing surgery than removing the tumor. Having an experienced skull base team decreases the risk.

 

Why choose Dr. B. Todd Schaeffer as your
endoscopic sinus and skull base surgeon?

Dr Schaeffer has been performing advanced
endoscopic sinus surgery for twenty years. He has
performed more endoscopic skull base surgery than
any other sinus surgeon on Long island. He commonly
works with skull base neurosurgeon Dr. Mark Eisenberg. As a team, they have successfully treated pituitary tumor removal, closure of CSF leaks, removal of encephaloceles, chordomas, clival tumors, meningiomas, craniopharyngiomas, odontoidectomy, spinal cord decompression, biopsies at the skull base and skull base reconstruction at North Shore University Hospital and LIJ Medical Center. The key to their success is collaboration together and the support staff of North Shore University Experience and team collaboration counts.

 

 

DO'S AND DON'TS AFTER SURGERY

  • Head of bed elevated on two pillows for three weeks
  • no nose blowing for three weeks
  • use saline Nasal Spray Several times a day for several months
  • No airplane flights for the first three weeks
  • No Strenuous activities or heavy lifting for three weeks
  • Expect to be out of work for three weeks.
  • Refrain from blood thining agents, i.e. Asprin, Advil, Motrin, Alleve for two weeks.
  • Avoid steam/extremely hot showers for three weeks.
  • Notify MD for Excessive bleeding from the Nose, Headache, Fever over 102 Degrees or Clear Fluid From the Nose.
  • Notify MD For Salty Taste in the throat.
  • Make Appointment to see Dr Schaeffer in his office after surgery at 3 weeks then monthly for the next three months.;
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Skull base team of Dr.
Eisenberg and Schaeffer

 


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