Not all pituitary tumors require surgery. Many are small and don’t affect hormone function or surrounding structures. These can be followed over time with MRI scans and as long as they don’t grow larger, they can be left alone. Some tumors can be stopped from growing and even shrunk with medical treatment, particularly tumors secreting the hormone prolactin. Sometimes medical treatment can even be curative. Sometimes surgery becomes necessary.
Most pituitary tumors can be removed in surgery that is performed through the nose. With the patient under anesthesia, the neurosurgeon, with or without the assistance of an otolaryngologist, passes instruments up the nose and into a sinus that lies behind the nose. A sinus is an air filled pocket in the bones of the skull. Under a microscope or television endoscope it looks a bit like a cavern. The tumor is removed in a piecemeal fashion until no further tumor can be found. Often television endoscopes are used to help look for left over tumor. The patient recovers in ICU and often patients can go home within a couple of days or so.