Home > B. Todd Schaeffer MD, FACS > Pituitary Tumors
Everything you need to know
ENT and Allergy Associates, LLP
Large tumor, usually non-secreting (hormone levels are normal),
cause headache or visual disturbance.
Small tumor, usually secretes hormone. Excess Growth Hormone (Acromegaly), excess ACTH (Cushing's Disease) or excess Prolactin (Prolactinoma).
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
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.
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.
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
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?
Large pituitary tumor eroding into
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.
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.;
Skull base team of Dr.
Eisenberg and Schaeffer
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