Pituitary Surgery in Indore

What is pituitary surgery?

The pituitary gland is a small gland at the base of the brain, just behind the nose and between the eyes. It controls many of the body's hormones, including those for growth, thyroid, stress, periods, fertility and water balance.

Most pituitary tumours (pituitary adenomas) are not cancer. They can cause problems in two ways. Some make too much of a hormone. Others grow large and press on the nerves for sight, causing loss of side vision, or press on the normal gland so it makes too little hormone.

The most common operation is endoscopic transnasal transsphenoidal surgery. The surgeon passes a thin camera (endoscope) through the nostril and the sphenoid sinus (an air space behind the nose) to reach the gland and remove the tumour. Larger or unusual tumours may need a different approach through the skull.

Who may need it

People with a pituitary tumour pressing on the nerves for sight, causing blurred vision or loss of side vision.

People with a tumour making too much growth hormone (acromegaly, with enlarging hands, feet and face) or too much cortisol (Cushing's disease). Surgery is often the first treatment for these.

People with a large tumour that is growing, even if hormones are normal.

People with sudden bleeding into a pituitary tumour (pituitary apoplexy), which can cause sudden severe headache and loss of vision and may need urgent care.

Prolactinomas (tumours that make too much prolactin, a milk-producing hormone) are usually treated with medicines first, and many never need surgery. Small tumours that cause no symptoms are often just watched.

Surgery is one option, not the only one. It is decided after an examination and a careful look at your scans, and non-surgical treatment is discussed first where it is suitable.

How it is done

1
Before surgery, an MRI of the pituitary, hormone blood tests and a detailed eye check are done. Any low hormones may be corrected first.
2
You are given general anaesthesia and are fully asleep.
3
The surgeon passes the endoscope and fine tools through one or both nostrils. An ENT (ear, nose and throat) surgeon may help with this part.
4
A small opening is made in the thin bone at the back of the nose to reach the sella (the bony pocket holding the pituitary gland).
5
The tumour is removed piece by piece while protecting the normal gland, the nerves for sight and nearby blood vessels.
6
The opening is sealed, sometimes with a tissue flap from inside the nose or a small graft. Soft packs may be placed in the nose for a short time.

Possible risks

Every operation carries some risk. Your surgeon will explain which of these apply to you.

Hormone problems after surgery. The gland may make too little of one or more hormones, sometimes needing lifelong hormone tablets.

Diabetes insipidus, where the body passes large amounts of urine and you feel very thirsty. It is often temporary but can sometimes last.

Changes in the salt (sodium) level in the blood in the days after surgery, which can cause headache, nausea or confusion.

CSF leak (leak of brain fluid), seen as clear watery drip from the nose, and meningitis (infection of the brain covering).

Nose bleeding, crusting, blocked nose, sinus infection or reduced sense of smell.

Worsening of vision, or injury to a major blood vessel near the gland. These are rare but serious.

The tumour may not be fully removed or may grow back, and may need further surgery, medicines or radiation. Anaesthesia also carries its own risks.

Preparing for surgery

Bring all MRI scans, hormone reports and eye test reports.

You will need hormone blood tests and usually a visual field test (a test of side vision). You will often be seen by an endocrinologist (hormone specialist).

If some hormones are low, such as thyroid or cortisol, you may be given replacement medicines before surgery. Take them exactly as prescribed.

If you take blood thinners, stop them only when and as your doctor advises.

Follow the fasting instructions given by the hospital, and tell the team about diabetes, high blood pressure or any other illness.

Arrange for a family member to stay with you. If you are coming from a nearby district, plan for a stay of several days in Indore.

Recovery

Most patients stay in hospital for about 3 to 5 days. During this time, urine output, thirst, blood salt levels and hormones are checked closely. A blocked nose and mild headache are common for the first one or two weeks.

For a few weeks, avoid blowing your nose, straining, heavy lifting and bending forward. If you need to sneeze, keep your mouth open. Report clear watery drip from the nose, severe headache, fever, extreme thirst or passing very large amounts of urine at once.

Follow-up hormone tests are done at intervals after surgery, and an MRI is usually repeated after a few months. Some people need hormone replacement for a while or for life, managed with an endocrinologist.

Questions patients ask

Will there be a cut on my face or head?

In most cases, no. The operation is done through the nostrils, so there is no visible scar. Rarely, a larger tumour needs an opening in the skull.

Do all pituitary tumours need surgery?

No. Prolactinomas are usually treated with medicines first. Small tumours that do not affect hormones or vision are often only watched with scans. Surgery is usually advised when vision is affected, when the tumour makes certain hormones in excess, or when it keeps growing.

Will my vision improve after surgery?

Vision often improves when pressure on the nerves for sight is removed, especially when it has not been affected for very long. If the nerve has been pressed for a long time, recovery may be partial.

Will I need hormone tablets after surgery?

Some patients do, for a short time or for life, if the gland does not make enough hormones. Your hormone levels will be checked after surgery and treatment adjusted as needed.

How long will I stay in hospital?

Usually about 3 to 5 days, so that fluid balance and hormones can be watched. Some patients need longer.

Who should I see first, a neurosurgeon or an endocrinologist?

Either is a good start, as both usually work together for pituitary tumours. Take your MRI and hormone reports to the consultation so the next steps can be planned.

Disclaimer: This information is for general awareness and is not a substitute for a medical consultation. Read moreSource: Content on this website was prepared with the help of AI tools (AI-assisted) and is medically reviewed by Dr. Kshitiz Nigam, MBBS, MS, MCh (Neurosurgery), Reg. No. MP-33282.