Pituitary adenomas

Pituitary adenomas

3D transsphenoidal for webpage IIIThe pituitary gland, or hypophysis (gr. “the growth which hangs below”) is a roughly spherical collection of hormone-producing tissues c. the size of a pea. It lies in a bony protuberence in the base of the skull and is connected to the brain by a narrow bridge of tissue, the pituitary stalk. The pituitary gland produces vitally important hormones, some of which act directly on target organs throughout the body while others have an effect on other hormone-producing glands. Important mechanisms ranging from growth to reproduction, as well as a host of metabolic functions, are controlled in this way.Tumors affecting the hormone-producing cells in the pituitary are called adenomas. Pituitary adenomas are tumors which arise from the various different cells of the anterior lobe of the pituitary gland and are nearly always benign (not cancerous). Some adenomas can produce active hormones leading to elevated levels of these hormones in the blood. In other cases, the expanding adenoma can damage other, healthy hormone-producing tissue, leading to a reduction or even complete cessation of the production of some hormones. Depending on the type of hormone produced, hormone-producing adenomas of the pituitary gland produce a range of clinical syndromes which can usually be diagnosed by a detailed panel of endocrine (hormone) blood tests. Some pituitary adenomas become large enough to put pressure on the optic nerves and can lead to visual problems.
To precisely diagnose pituitary adenomas, imaging with CT and MRI alongside opthalmological and endocrinological examinations is required. High resolution and spatial magnetic resonance imaging (MRI and MRA) and computer tomography (CT) is particularly useful in identifying the precise relationship of large blood vessels (such as the internal carotid artery), the optic nerves and other structures of the skull base to the tumor – these are critical steps in planning any operation which may be necessary..
pitThe approach to treating pituitary adenomas must be carefully considered. Factors such as hormone activity, the size of the tumor and its proximity to the optic nerves and blood vessels as well as any coexisting diseases must be investigated and weighed up. An operation is not necessary in all cases and some pituitary adenomas can be successfully treated with medications only.

If an operation is necessary, there are now many techniques available to remove an adenoma precisely and with the absolute minimum damage to healthy tissue. In every case, however, the surgery begins with thorough pre-operative planning. This consists of taking high-resolution MRI and CT images of the tumor and its neighboring structures and producing a detailed 3D reconstruction of the patient’s anatomy and the planned surgical approach.

Nearly all pituitary tumors can be treated using a minimally-invasive surgical approach through the nostril of the nose and the bone behind the nose, known as the sphenoid bone. This technique is called an endoscopic transsphenoidal approach. In our clinic we have access to the most modern tools and equipment. State-of-the-art intraoperative MRI (PoleStar) allows us to constantly check the progress of tumor removal and ensure that, even in difficult to reach areas, a complete resection of the adenoma is made as easy as possible. A computer-controlled 3D navigation system uses data from the PoleStar MRI and allows us to perform “target-oriented” operations eliminating the need for “exploration” around the adenoma which carries the risk of collateral damage to important structures. In many cases we perform these operations alongside our otolaryngology colleagues

using the most up-to-date endoscopic techniques, using a tiny camera which enables us to reach the surgical target area and visualize the tumor and its boundaries, further facilitating total resection.

Before and after the operation you will also be looked after by a multidisciplinary team of internal medical doctors and endocrinologists, ensuring you get the best possible all-round care.