When a pituitary tumour is suspected, a physician will perform a physical examination and vision testing to detect loss of peripheral vision. Hormone testing of the blood and urine and MRI of the brain are used to confirm diagnosis.
Early intervention provides the best chance for cure or control of a pituitary tumour and its side effects. There are three types of treatment used for pituitary tumours: surgical removal of the tumour, radiation therapy to destroy tumour cells and medication therapy to shrink or eradicate the tumour. Hormone replacement therapy may also be required.
For prolactinoma, treatment of choice is medical therapy. With medical management, about 80 percent of patients have prolactin levels restored to normal. If the tumours do not respond to medication therapy, then surgery is considered.
For all other tumours, surgical removal is the treatment of choice. For residual or recurrent tumours and when the patient is not fit for surgery, radiotherapy and/or medical treatment is considered.
The pituitary gland lies in the roof of sphenoid sinus in an area called sella turcica. it is surrounded on either side by the internal carotid arteries (which takes blood to brain) and above by the optic chasm and brain.
Most of these tumours are approached through the nasal cavity and sphenoid sinus. It is known as transsphenoidal approach. Microscope was used earlier for this surgery. Currently, building on the experience in endoscopic sinus surgery, otolaryngologists accumulated considerable expertise in pituitary tumour resection
aided by endoscopic techniques (Fig.1.3). The endoscope enables a panaromic view of the sella with excellent magnification and illumination superior to the operative microscope (Fig.1.4). Angled scopes allow the surgeon to view the hidden areas (lateral parasellar and suprasellar areas) which was not possible with the microscope. The improved visualization possible with the endoscope reduces carotid and hypothalamic injury and makes it possible to remove the tumour completely. Computer assisted surgical navigation system is used where the pneumatization of sphenoid is of pre-sellar / conchal type. Currently, transnasal endoscopic transsphenoidal surgery is the preferred surgical technique.
The transcranial approach, or craniotomy, is less commonly used and reserved for particularly large and invasive tumours which cannot be safely removed through the transsphenoidal route.
Most of the pituitary adenomas (>95%) are removed via the nose using endoscopic endonasal technique. At Apollo Cancer Centre, we aim at maximizing tumour removal and minimizing complications through experience and use of the best use of technology including high-definition endoscopy, intraoperative navigation and the endoscopic Doppler probe for blood vessel localization (Fig.1.5).
From January 1997 to December 2020, our team at the Apollo Cancer Centre, Chennai has carried out 1245 endoscopic pituitary surgeries successfully. Out of 1245 sellar lesions we managed, 96% of them are pituitary adenomas. Other conditions treated were craniopharyngiomas (2%), meningiomas (0.2%), Rathke’s cleft cysts (0.4%), inflammatory lesions (0.6%) and malignant tumours (0.16%). Youngest patient we have operated so far was 8 years old and the age of the patient need not be a limiting factor.
Surgery for pituitary lesions has become greatly refined from the time Cushing described transsphenoidal approach. Endoscopic transsphenoidal pituitary surgery is now a proven and safe method of removing pituitary lesions and has been embraced as the preferred technique the world over.
