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Pituitary tumours

Surgical management of tumours of the pituitary gland

  • We were among the first in the Czech Republic to adopt an operating path through the nostril
  • A combination of microscope and endoscope in visualizing tumours
  • Careful monitoring of patients during postoperative and follow-up care

The pituitary gland is located in the middle of the skull base in the so-called Turkish saddle (sella turcica) area. It is an endocrine gland  and the centre for the hormonal activity of the entire organism. The most common pituitary tumours are adenomas. Even though these are benign tumours, their location may cause pressure and the malfunction of important centres in the skull base. Furthermore, large quantities of adenomas uncontrollably produce hormones that negatively affect the patient’s health.

Treatment

Different types and subtypes of adenoma cause corresponding sets of symptoms (syndromes), and their treatment also varies. Medication is sufficient to treat lesions, but in most cases surgical removal of the tumour is required, especially if the tumour mass is pushing on the optic nerves and causing deterioration or loss of vision. Less frequently, other tumour processes occur in the Turkish saddle – surgical procedures for lesions in this area is very similar and highly specific in neurosurgery.   The decision to operate requires endocrinological and eye examinations (perimeter evaluation), and detailed magnetic resonance screening is also necessary.

Surgical procedures

The most common approach is through the nostril wedge cavity. This is a minimally invasive method with rapid healing, without visible scars and without direct contact with the brain. The aim of the operation is to selectively remove the tumour while preserving the healthy gland. For larger tumours the approach can be made through the skull beneath the frontal lobe of the brain, sometimes a combination of these two methods is used. Nowadays we use a combination of microscope and endoscope for the best visualization of the tumour.

After surgery

After the operation, the patient wears a nasal tamponade for two to four days, during which they cannot breathe through their nose. Hospitalization lasts about a week, and the patient is released for home care after consultation with an endocrinologist, who provides postoperative hormone therapy.  The patient goes on to receive neurosurgery and endocrinology care, which conducts further