Pituitary Surgery and Its Complications

What Is Pituitary Surgery?

Pituitary Surgery is an operation that involves the surgical removal of tumors or masses that develop in the pituitary gland, located at the base of the brain and known as the “hormonal control center” of the body. The pituitary gland regulates the functions of many organs, including the thyroid, adrenal glands, reproductive hormones and growth hormones. Therefore, a tumor in this area may cause numerous serious problems ranging from hormonal imbalances to vision loss.

Prof. Dr. Ömür Günaldı emphasizes that Pituitary Surgery must be performed using a multidisciplinary approach and that the combined assessment of neurosurgery, endocrinology and ophthalmology specialists plays a major role in treatment success.

Although the pituitary gland is approximately the size of a pea, it is the central organ of body metabolism. Even small tumors in such a tiny structure can cause serious systemic disorders. Therefore, surgical intervention is performed both to restore hormonal balance and to eliminate nerve compression.

What Are Pituitary Tumors?

Pituitary tumors are benign (adenomas) or, rarely, malignant cell growths that develop in the pituitary gland. These tumors usually grow slowly but may cause various symptoms by compressing surrounding structures.

Hormone-Secreting Tumors

These tumors are characterized by excessive hormone production.

• Tumors that secrete prolactin (prolactinomas)
• Adenomas that produce growth hormone (leading to acromegaly)
• Adenomas that secrete ACTH (causing Cushing’s disease)

Non–Hormone-Secreting Tumors

These do not affect hormonal balance but may cause headaches and vision loss by pressing on surrounding tissues.

Prof. Dr. Ömür Günaldı notes that most pituitary tumors are benign, but surgical intervention may be required due to their effects on hormonal balance.

When Is Pituitary Surgery Necessary?

Pituitary Surgery is preferred in tumors that do not respond to medical treatment or that compress the optic nerve.
The main reasons include:

• Narrowing or blurring of the visual field
• Metabolic disorders due to excess hormone production
• The tumor growing and compressing the hypothalamus or optic nerve
• Medical treatment proving insufficient

Prof. Dr. Ömür Günaldı emphasizes that the decision for surgery is based not only on tumor size but also on the patient's overall condition, hormone levels and neurological findings.

Preparation Before Pituitary Surgery

Before surgery, detailed hormone tests, MRI imaging and eye examinations are performed.

Endocrinological evaluation: Determines which hormones are overproduced or deficient.
Visual field test: Assesses compression on the optic nerve.
Brain MRI: Identifies the size, location and structural relations of the tumor.

Prof. Dr. Ömür Günaldı states that meticulous preoperative planning directly affects surgical success.

Methods Used in Pituitary Surgery

Transsphenoidal Surgery

The most commonly used technique. The tumor is reached through the nose or sinus cavity. Since there is no direct intervention on brain tissue, the risk of complications is reduced.

Endoscopic Technique

High-resolution images are provided with camera systems. The surgeon can see the tumor clearly and operate with greater precision.

Craniotomy (Open Skull Surgery)

Preferred when the tumor is large or located in an area inaccessible by other methods.

Prof. Dr. Ömür Günaldı states that endoscopic Pituitary Surgery performed through the nasal route is preferred in most patients today and requires no external incision.