Pituitary tumours, or pituitary adenomas, require surgery in specific clinical situations, and understanding when surgery is and is not indicated is important because not every pituitary tumour needs to be operated on. The indications for surgery are: visual field defects, where the tumour has grown upward and is pressing on the optic chiasm producing characteristic bitemporal vision loss that is often first noticed as difficulty seeing objects to the sides; hormonal excess syndromes that do not respond adequately to medical management, including Cushing's disease from excess ACTH, acromegaly from excess growth hormone, and some cases of hyperprolactinaemia that do not respond to dopamine agonist medication; significant mass effect with headache and pituitary insufficiency; and tumours that are growing rapidly on serial MRI. For most pituitary macroadenomas that require surgery, the operation is performed endoscopically through the nasal cavity. An endoscope, a thin rigid camera, is passed through the nose to the back of the nasal cavity, where a small opening is made into the sphenoid sinus, the air cavity immediately in front of the pituitary gland. The tumour is then directly visualised and removed through this natural corridor without any external skin incision, without moving the brain, and without a conventional craniotomy. My 2024 publication in World Neurosurgery, which examined the optico-chiasmatic distortions produced by large pituitary macroadenomas and the relationship between postoperative morphological reversal of the chiasm and visual recovery, reflects the detailed interest I bring to the visual outcomes of this procedure. Most patients undergoing endoscopic transnasal pituitary surgery at Apex Hospital or Gudage Hospital, Bidar, are in hospital for one to two days, and the majority experience meaningful improvement in visual field defects if the chiasm decompression is achieved.
Written by Dr. Prashanth Alle, MBBS, ECFMG (USA), DNB (Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru), Consultant Neurosurgeon, Apex Hospital, Bidar (Monday to Saturday, 11:00 AM to 2:00 PM, +91 9036360396) and Gudage Hospital, Bidar (Monday to Saturday, 3:00 PM to 5:00 PM, +91 84822 26841). 18,200+ patients. Phone: +91 9632384477.
