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Endoscopic Pituitary Tumor Surgery or Transcranial Pituitary Tumor Surgery in New Jersey

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Pituitary tumors can disrupt a patient’s vision and hormone function. Fortunately, many pituitary tumors are benign. Surgical methods for treating pituitary tumors can be either an endoscopic surgery that is minimally invasive, leaving no scar, or a transcranial surgery, generally referred to as a craniotomy.

Serving patients throughout northern New Jersey, the medical staff at Centers for Neurosurgery, Spine & Orthopedics (CNSO) has extensive experience performing successful pituitary tumor surgeries. Learn more about these types of surgeries and what patients can expect before, during, and after the procedures.

What Is a Pituitary Gland and What Is a Pituitary Tumor?

The pituitary gland is pea-sized and sits at the base of the brain. It is an endocrine gland that produces hormones which regulate crucial bodily functions, such as:

  • Growth
  • Metabolism
  • Breast milk production
  • Blood pressure

A pituitary tumor develops when cells in this gland mutate and excessively grow. It is not clear what causes pituitary tumors, but most are benign and grow slowly without spreading to other parts of the body. When the size of the pituitary becomes too large, or the pituitary gland produces too many hormones, the patient begins to experience problematic symptoms.

Indications for Endoscopic Pituitary Surgery

There are two surgical approaches for pituitary tumors – transsphenoidal and transcranial. A transsphenoidal approach is an endoscopic brain surgery that accesses the growth through the patient’s nostrils, which limits scarring and blood loss. If the tumor cannot be removed through the sinus cavity, the best option is transcranial surgery.

Indications for Transcranial Surgery

A transcranial approach may be necessary depending on the size of the tumor and other anatomical structures of the individual patient. Transcranial surgery means “through the skull.” In this type of brain surgery, a neurosurgeon removes a small piece of the patient’s skull to access the pituitary gland or other brain structures.

Treatment options for pituitary tumors include brain surgery, radiation therapy, and medication. Generally, surgery is recommended if the tumor is causing hormonal imbalances or is pressing against surrounding nerves.

Diagnosis and Preoperative Evaluation

Some pituitary tumors make extra hormones, while others interrupt normal pituitary gland functioning. Thus, the signs and symptoms can vary, but may include:

  • Headache
  • Changes in vision
  • Loss of body hair
  • Infertility or less frequent menstruation
  • Lowered sex drive
  • Weight gain in the face, neck, or trunk
  • Irregular heartbeat
  • Nausea or vomiting
  • Dizziness
  • Seizures

Diagnostic testing typically includes imaging, such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain. A provider may order blood tests to check a patient’s hormone levels. Additionally, pituitary tumors can cause vision problems, so a patient may need a visual field test.

Neurosurgical Team and Expertise

CNSO boasts an experienced, multidisciplinary team of providers collaborating to deliver personalized care. The board-certified neurosurgeons and orthopedic spine surgeons at CNSO take a conservative approach to care, recommending surgery only when necessary to achieve the best health outcome.

Types of Pituitary Tumors

Pituitary tumors may be benign or malignant (cancerous). Most pituitary tumors are known as pituitary adenomas. They may be functioning (meaning they produce hormones) or nonfunctioning. Functioning tumors are further classified based on the type of hormone they produce. Types of functioning pituitary adenomas include:

  • Prolactin-producing adenomas
  • Adrenocorticotropin-secreting adenomas
  • Thyrotropin-secreting adenomas
  • Gonadotropin-secreting adenomas
  • Multihormonal adenomas

If a pituitary tumor invades other parts of the nervous system, it is labeled as a pituitary carcinoma. These types of tumors are very rare.

Preoperative Preparation

Before a patient undergoes brain surgery, they will have a series of tests and assessments. Their treatment plan will depend on several factors, including:

  • The type of pituitary tumor
  • The tumor’s size
  • The patient’s symptoms
  • Whether the tumor is producing hormones
  • Whether the growth has spread to other parts of the brain

The patient may need additional imaging to help develop a surgical plan.

Surgical Procedure

To perform endoscopic surgery, neurosurgeons and ear, nose, and throat (ENT) surgeons will access the pituitary gland through the nose. Tools are inserted through the patient’s nostrils and up to the base of the skull. The neurosurgeon will proceed from the base of the skull to the pituitary gland.

For a craniotomy, a neurosurgeon will make a small incision in the patient’s scalp after shaving and disinfecting a portion of the patient’s head. The incision typically is within the hairline, so the scar often will be hidden by the patient’s hair once it grows back. A small piece of the patient’s skull is removed so the neurosurgeon can access the tumor. They will then excise (remove) as much of the growth as possible. The portion of the skull that was removed is replaced, and the incision site is closed with stitches or staples.

Brain tumor surgery for a pituitary tumor is performed under general anesthesia, meaning the patient is unconscious throughout the procedure. Given the sensitive nature of the anatomy, the patient must remain still.

Intraoperative Challenges in Pituitary Tumor Surgery

The goal of either endoscopic brain surgery or transcranial surgery is to remove as much of the pituitary tumor as possible without damaging the healthy pituitary gland tissue. The neurosurgeon must navigate delicate brain structures, including the hypothalamus above the pituitary gland. In some cases, a neurosurgeon can use minimally invasive brain surgery techniques to minimize bleeding and scarring.

Minimally Invasive Techniques Other Than Endoscopic Brain Surgery

One minimally invasive option for transcranial surgery is supraorbital craniotomy, sometimes colloquially referred to as eyebrow craniotomy. This procedure uses a small incision in the eyebrow to access the front of the brain. Depending on the size and structure of the pituitary tumor, a neurosurgeon may be able to use a supraorbital craniotomy approach to remove the growth using microsurgical tools. The benefits of this approach include:

  • Decreased exposure of the brain tissue
  • Minimal disruption to scalp and muscle tissue
  • Shorter recovery time than traditional craniotomy
  • Less postoperative pain
  • Minimal scarring at the incision site

Recovery and Postoperative Care

After brain surgery, a patient will be moved to a recovery room while they wake up from anesthesia. They will be closely monitored and will have bandages on their head to cover up the incision site. The patient may need to stay in the hospital for up to a week. They will begin rehabilitation while still in the hospital. To minimize the risk of blood clots, the medical staff will help them get up and walk around regularly.

Some patients will need medication after surgery. This can include:

  • Medication for postoperative discomfort or swelling
  • Antibiotics to prevent infection
  • Hormone replacement therapy

Any stitches or staples usually can be removed within seven to 10 days. After discharge from the hospital in one to two days, the patient will have follow-up appointments with the neurosurgeon and endocrinologist.

Potential Complications

While surgery often is the best option for treating pituitary tumors, it does carry the risk of complications. Possible complications after endoscopic and transcranial surgery include:

  • Excessive bleeding
  • Leakage of cerebrospinal fluid
  • Meningitis or other infections
  • Adverse reaction to anesthesia medication

Both surgery and radiation therapy for pituitary tumors can lead to hypopituitarism. This is a condition in which the pituitary gland stops producing one or more kinds of hormones. Hypopituitarism is a reduction in any of the below hormones:

  • Adrenocorticotropic hormone (ACTH) deficiency: This hormone regulates adrenal gland function and helps the body react to stress appropriately.
  • Anti-diuretic hormone (ADH) deficiency: ADH regulates fluid levels in the body.
  • Growth hormone (GH) deficiency: In children, GH deficiency can lead to growth problems and social-emotional developmental issues.
  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency: FSH and LH help control the reproductive system.
  • Prolactin deficiency: This hormone regulates the production of breast milk.
  • Thyroid-stimulating hormone (TSH) deficiency: This regulates the thyroid gland, and irregular levels can affect energy and body weight.

Fortunately, hypopituitarism can be managed with hormone replacement medication.

Rehabilitation and Support Services

It can take several weeks to months to recover from brain surgery. Most patients will be discharged from the hospital after one to two days but must rest at home before returning to work or school. A patient must be cleared by their medical provider to drive a vehicle or participate in any strenuous activity.

Success Rates and Long-Term Outcomes

Pituitary tumors can be malignant or benign. For patients with benign pituitary gland tumors, the five-year relative survival rate at CNSO is 99.9%. Nationally, the five-year survival rate for all kinds of pituitary tumors is 97%. Success rates for surgical removal of pituitary tumors will depend on several different factors, including:

  • The type of tumor
  • The tumor’s size
  • The patient’s overall health

Frequently Asked Questions About Transcranial Surgery for Pituitary Tumors

Here are common questions asked by patients regarding pituitary tumor surgery:

How common are pituitary tumors?

Across the United States, more than 10,000 patients are diagnosed with pituitary tumors each year. Most of these are benign pituitary tumors.

When is transcranial surgery recommended?

Surgery is the most common form of treatment for pituitary tumors. Transcranial surgery usually is recommended if a tumor is too large to be removed through the patient’s sinuses.

How does a patient prepare for transcranial surgery?

Before a patient has transcranial surgery, their neurosurgeon will explain the procedure and the surgical approach. The patient will have a physical examination before being cleared for surgery and may undergo tests like blood work, imaging, and neurological testing. Usually, the patient must refrain from eating or drinking for several hours before the procedure.

What are the potential complications of this surgery?

Potential complications of transcranial surgery include:

  • Blood clots
  • Infection
  • Swelling of the brain
  • Leakage of cerebrospinal fluid

As with any surgery performed under general anesthesia, there is a chance that the patient will have an allergic reaction to the anesthesia medication.

How long does it take to recover from transcranial surgery?

Patients having transcranial surgery may need to stay in the hospital for up to a week afterward. Stitches can be removed within 10 days, but it will take three to four weeks to heal the incision site fully. Complete recovery can take several months.

Are there minimally invasive alternatives?

Some patients with pituitary tumors can be treated with a minimally invasive type of endoscopic surgery or transcranial surgery known as supraorbital craniotomy, which accesses the tumor through a small incision in the eyebrow.

Find Expert Neurosurgery at CNSO

Patients with pituitary tumors and other types of brain tumors can find expert treatment at Centers for Neurosurgery, Spine & Orthopedics (CNSO) in northern New Jersey. As the state’s most comprehensive center for brain and spine care, CNSO is staffed by a team of experienced neurosurgeons who work collaboratively to deliver personalized treatment plans. CNSO’s medical staff includes neurosurgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists.

Patients at CNSO can take advantage of telemedicine services and choose from multiple locations in northern New Jersey to receive convenient, accessible care. Philosophically, the team at CNSO takes a conservative approach to pain management and treatment throughout the patient journey, offering expertise at each stage of care. To learn more about surgical and non-surgical treatment options at CNSO or to request an appointment, contact CNSO today.

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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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