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The most common treatment for pituitary tumors is surgery. Unless the patient is suffering from a prolactin, secreting tumor, most pituitary tumors are treated with surgery. Prolactin, secreting tumors are treated by medications that are taken orally by the name of bromocriptine or cabergoline. These medications will shrink prolactin, secreting tumors, and then the tumors can be followed using MRIs on tumors that are smaller and secrete other hormones. Surgery is definitely the best option. It is performed through the nostrils by a neurosurgeon or a neurosurgeon team. The surgeon exposes the bottom of the skull by going through the nostril using an endoscope or a microscope. Then the base of the skull is drilled off and the computer system is used to gauge the depth within the patient’s head. The tumor is then removed using ring curettes. And once the tumor is completely resected, the remaining space is filled with fat, which is harvested through a small incision in the right lower part of the abdomen.
Surgery itself takes two to three hours on the average and it can achieve a curative resection. Approximately 85% of the time, 15% of people are left with some level of tumor remnant. And sometimes a patient may be told that they had a full resection, but the tumor may still recur due to a small residual within the sides of the cella, which is a very complex and small space. Most people spend one to two days in the hospital being monitored for hormonal imbalances, the patients with moderate hormonal imbalances will stay longer in the hospital to be treated. The most common risk of pituitary tumor surgery through the nostril are headaches, hormonal issues, and leaking brain fluid through the nostrils and sinus infections. Uncommon risks that are less than one in a thousand are things such as stroke, double vision and meningitis. Once the tumor has been partially or totally resected, MRI followups are a standard of care. If the tumor is only partially resected and the MRI shows a substantial remnant, radiation is a good choice for most of these tumors in order to reduce the chances of future surgical needs on patients who are older and have substantial medical problems, they may benefit from radiation without surgery, but most people are offered surgery and moderate and large size tumors, especially if they have visual symptoms or hormonal symptoms.
