Pituitary Tumor Treatments & Procedures

Treatment for a pituitary tumor depends on the type, size and position of your tumor, plus your age and overall health. The specialists at the Houston Methodist have access to advanced technology to detect, diagnose and treat pituitary adenomas (non-cancerous), pituitary carcinomas (cancerous), and other types of tumors that grow in and around the pituitary gland. Our doctors work collaboratively and seamlessly with specialists from other areas of medicine so patients benefit from the full breadth of Houston Methodist Hospital excellence.

Most pituitary tumors can be treated. Virtually all tumors can be removed surgically or reduced in size with other means, and prognosis for patients is excellent.

Treating Pituitary Tumors
World-class doctors in many specialties, including neurosurgeons, neuro-oncologists, radiation oncologists, medical oncologists  and researchers at Houston Methodist offer the latest approaches to removing brain tumors while preserving function: 

Sometimes, the safest course of treatment for patients is simply to observe and monitor the growth of a tumor. Many tumors are small and are not growing or are growing very slowly. These tumors may have few adverse impacts on a patient's health. For older patients (age 70 and older), observation, with regular visits to your doctor may be recommended.
Treatment with Medication
One type of pituitary tumor, called a prolactinoma because it causes an increase in the production of the hormone prolactin, can be effectively treated in many cases with the drugs bromocriptine or cabergoline. These drugs stop tumor growth, often cause a reduction in the size of the tumor and usually decrease excess prolactin. Drug treatment does not usually eliminate the tumor, however, and treatment must be continued over a period of many years. Side effects from the drugs include nausea, headaches, dizziness and weakness, but may be managed by slowly increasing the amount of drug being used. Drug treatment may be selected as the only treatment needed, or it may be used in combination with other treatments.
Tumors that make growth hormones can also be treated with medication. Usually medication is used to control residual tumors that cannot be safely removed surgically, and often can help avoid the use of radiation treatments.
Focused Radiation or Radiotherapy/Stereotactic Radiosurgery
Highly focused radiation therapy, called stereotactic radiosurgery, is sometimes used after surgery in the minority of cases in which the tumor cannot be completely removed. Many people think radiotherapy is only used in cases of cancer, but it can be even more effective in treating pituitary adenomas and other benign tumors. (For more information about the different forms of radiation therapy  that are available, please click here.)
This technique focuses two or more lower-intensity radiation beams at the tumor with minimal effect on surrounding tissue. Radiation therapy is painless, and treatment can often be performed in one to five sessions on an outpatient basis. Newer techniques have much less effect on the surrounding pituitary gland than older approaches, and in most cases can spare pituitary function.
Depending  on the nature of the pituitary adenoma or carcinoma, your doctor may recommend surgical removal. Surgery can almost always be performed in a minimally invasive way, endoscopically, through the nose. (For more information about surgical options , please click here.) Alternately, standard surgical removal may be recommended through craniotomy, in which a small portion of the skull is removed so surgeons can access the tumor. Advances in surgical technology make even the craniotomy minimally invasive.

The Transsphenoidal Approach to the Pituitary Gland

The transsphenoidal (minimally invasive) operation is the most common for a pituitary tumor. The approach for this operation is through the nose, so there is no incision. This surgical approach takes advantage of the fact that the pituitary gland is located on top of a hollow air sinus at the base of the skull. Using an approach through the nasal passages, one can enter into the sinus, remove the bone separating the sinus from the pituitary, and then remove the tumor without damaging any of the brain structures. The procedure is done with an endoscope, which is a slender rod (2.8 mm in diameter) with a camera on the end of it. This surgical approach provides the best exposure of the tumor with the lowest risk. Advances in technology have provided very high resolution pictures (1080 P or Blu-ray type definition) from the endoscopes that are now used to remove these tumors. The operation normally takes two or three hours. Following the operation, most patients spend one day in the intensive care unit, then typically just one day in their hospital rooms. In many cases, patients are sent home the day after surgery. The surgery has been converted from a very high-risk procedure with a prolonged recovery time to a minimally invasive operation with a very rapid return to work and minimal side effects .

Evolution of Modern-Day Surgical Approaches to the Pituitary Gland
In recent years, surgery to remove pituitary tumors has been primarily through the nasal passages, rather than using more invasive approaches in which the skull is opened. The older and more classical approach is to remove pituitary tumors is via an incision underneath the lip (sublabial), which provides access to the nasal passages. This procedure produces numbness in the teeth and requires a more extensive recovery, usually involving a prolonged period of sinusitis and the use of nasal packs and splints. A more recent development is the use of the transseptal approach, where an incision is made in the front of the nose to gain access to the pituitary region. While this is an advance, it still involves an extensive nasal dissection (cutting) and a more prolonged recovery because of symptoms and complications relating to manipulation of the nasal structures.

Using the endoscopic endonasal approach, there is no dissection through the nasal structures. The sinuses are entered through the very back of the nose, with excellent exposure of the pituitary gland and its surrounding structures. This is the least invasive technology available for removal of pituitary tumors today, and provides optimal surgical exposure, the fewest nasal complications and excellent outcomes.
Craniotomy for Pituitary Tumors
The craniotomy operation involves making an incision on the scalp. A small piece of bone is lifted out and the coverings over the brain are opened. Advances in surgical techniques at Houston Methodist mean that tumor removal can be performed using virtual reality navigation and no longer requires lifting or moving brain structures. Rather, surgery is performed through natural crevices in the brain, without entering into the brain at all or manipulating it as has been necessary in the past. The small piece of bone is then replaced and the scalp is closed with stitches or staples. In all cases, the incision on the head can be placed so that the hair hides the scar. This type of operation is sometimes necessary if the tumor is very large and/or it cannot be reached through the nose.


Our physicians at Houston Methodist specialize in treating  pituitary tumors at the following convenient locations.