1. The outpatient doctor told me that according to my current condition, I need to be hospitalized for a transsphenoidal pituitary adenomectomy. My head got big and my back got cold when I heard about the surgery, and no one around me has ever had this surgery, so I was scared! Doctor, what does “pituitary adenomectomy” mean?
To understand this kind of disease, we need to understand what the pituitary gland does: the “pituitary gland” in our brain is the general headquarters of the human neuroendocrine system, while “pituitary adenoma” is a benign tumor from the pituitary gland itself. Only a few cases of malignant lesions have been reported worldwide, and the vast majority of patients with pituitary adenomas have benign tumors or other lesions of the pituitary gland.
Clinically, we divide pituitary adenomas into two categories: one type of pituitary adenoma has a hormone-secreting function and is still “hard at work” for the body like a hard worker, producing a constant flow of all kinds of hormones necessary for the body – only it is so hard-working that it produces too many hormones and thus has an impact on the body. It produces too many hormones and thus has an adverse effect on our body. For example, the most common hormone is prolactinoma, which can cause irregular menstrual cycles and even amenorrhea in women, failure to conceive in young women, and abnormal milk production during non-lactation periods. The clinical treatment is divided into medication and surgery. Since there are now specific medications for prolactinomas, most patients with prolactin adenomas are treated by endocrinologists who specialize in pituitary function disorders and rarely require surgery. However, there are some functional adenomas that require aggressive surgical treatment, and these pituitary adenomas often cause acromegaly and Cushing’s disease in patients. “Acromegaly (or “gigantism” in childhood onset) is caused by “overactive” growth hormone-secreting cells in the pituitary gland, which produce large amounts of growth hormone, causing the patient to Cushing’s disease is the same, because the pituitary gland overproduces adrenal hormone, which acts on the patient’s adrenal glands and then causes excessive secretion of adrenocorticotropic hormone, resulting in “full moon face”, “buffalo back”, and “centripetal obesity”. This causes symptoms such as “full moon face”, “buffalo back” and “centripetal obesity”. For this type of pituitary adenoma, after surgical removal, the hormone level in most patients can be restored to normal and the symptoms can be relieved.
The other type of pituitary adenoma does not secrete hormones, which is called “non-functional pituitary adenoma”, it is like a lazy man who just keeps on “getting fat” but does not work, and does not produce any hormones that are useful to the body –But this “fat pituitary” is so fat that it compresses our normal pituitary tissue. Compression of normal pituitary tissue causes dysfunction, resulting in a decrease in normal hormone production, so unlike the “overactive” functional pituitary adenoma, this pituitary gland can be in a hypofunctional state. In addition, continued enlargement of the tumor can compress the normal structures surrounding the pituitary gland (occupying effect), which can lead to symptoms such as headaches and visual field defects. Therefore, although pituitary adenomas are small, they are dangerous and require clinical intervention. For tumor types that cannot be controlled by medications, the tumor can be surgically removed to relieve the compression of the surrounding tissues and relieve symptoms.
The pituitary gland is located in the intracranial “traffic artery”, and its surrounding structures are very important, which affect the whole body. The ophthalmic and maxillary branches of the trigeminal nerve (CN V1, CN V2), as well as the abducens nerve (CNVI) and the cavernous segment of the internal carotid artery, located in the center of the cavernous sinus, are arranged from top to bottom. The abducens nerve and the cavernous sinus segment of the internal carotid artery are more likely to be injured because they are closer to the pituitary gland.
2. I have heard from friends who have undergone surgery that they don’t know anything after anesthesia. Doctor, how does pituitary tumor surgery work? I want to know so I can have a good idea!
Most pituitary adenomas are not allowed to be opened, but are removed minimally invasively through the nostrils and pterygoid sinuses. The pterygoid sinus is an air cavity surrounded by bone not far from the posterior nostril, and its bony structures encircle the area where the pituitary gland is located, the pituitary fossa. The pituitary gland sits precariously on top of this depression on the back of the pterygoid bone like a horse, hence the name of this part of the pterygoid bone, the saddle. The surgery is performed through the nostrils, and by opening the pterygoid sinus into the pituitary fossa, the surgeon is able to perform the surgery with the help of a microscope or endoscope, in a smaller surgical space and with less side trauma. However, in some special cases, we also need to perform craniotomy in order to fully reveal the larger tumor.
3. The pituitary gland is located in the middle of the skull and is very deep, so how can we reach the pterygoid saddle?
There are three basic paths in surgery. Currently, internationally, most neurosurgeons apply the direct transnasal route. There are two strategies: one is to enter the pterygoid sinus through the posterior nostril and perform the surgical operation of pituitary tumor removal; the other is to reach the pterygoid sinus through a “tunnel” along the nasal septum, which is slightly more invasive. There is also a traditional approach, the sublabial approach, which is still used by a few surgeons, in which an incision is made at the root of the upper lip, i.e., the root of the upper teeth, and the nasal cavity is entered through the upper gingiva to reach the pterygoid sinus.
Transsphenoidal approach: I transnasal approach (now the most commonly used approach), II transseptal approach (largely abandoned worldwide), III sublabial approach (still partially used).
4. Doctor, you said that transnasal pituitary tumor resection is now mainly applied, but my nostrils are so small, what equipment and techniques does the surgeon use to observe the tumor intraoperatively?
Indeed, the operating channel of the transsphenoidal approach is very small, about less than 2 cm in diameter. Therefore, it is necessary to use auxiliary tools to understand the condition of the tumor in the surgical area. With the rapid advances in technology, aids dedicated to the delicate local surgical operations have been developed, namely high magnification surgical microscopes and fiberoptic endoscopes, which can help surgeons to view the tumor area in detail through small holes.
Surgical microscopes can provide surgeons with high quality double-pupil stereoscopic vision, which is very helpful for removing microscopic tumors (e.g., those causing Cushing’s disease); while endoscopes can provide a broader field of view, especially angled endoscopes that can see lesions beyond the reach of direct vision, with the disadvantage that endoscopic views are like watching a TV screen, which is monocular and requires a high level of physician proficiency. This requires a high level of proficiency. In the neurosurgery department of Peking Union Medical College Hospital, the trans-pituitary approach to the saddle area is performed by microscope or endoscope, sometimes even both, and nearly 1,000 such surgeries are performed every year.
5.The pituitary gland is deep in the brain, so far from the nostril, and the bony opening is very small, what tools and methods does the surgeon use to remove the tumor?
Pituitary adenomas are usually soft and can be scraped out with a long-handled spatula. In order to be able to remove a large tumor through a small hole, we can cut the tumor into small pieces and remove it in pieces. Please imagine: now there is a large tumor that we need to remove cleanly through a smaller bony opening. The surgical instruments can only reach the central part of the tumor through the bony window, and to remove the tumor satisfactorily, it is necessary to ensure that the surrounding tumor can be hollowed out to the core of the tumor and then collapse into an area that can be reached by the operator’s surgical instruments before continuing to be removed. However, there are often giant pituitary adenomas that have growth boundaries beyond the normal growth range of the pituitary gland (pterygoid saddle) and the peripheral tumor cannot be removed intact. For example, if the tumor overgrows horizontally and protrudes into the cavernous sinus (located on both sides of the pterygoid saddle, which is the area where the veins of the human head and face converge.) However, if the tumor is overgrown upwards, i.e. the majority of the tumor is located above the pterygoid saddle, then the tumor above may “fall off” after the tumor below has been removed, and can be further removed. With this in mind, we sometimes divide the resection of a giant pituitary adenoma into two stages: first we try to remove the pituitary adenoma “below” the septum during surgery, and then the tumor “above” the septum is dislodged by raising the intracranial pressure during surgery. The tumor “falls” into the saddle area, and then continues to be removed surgically, in some cases even in two stages.
6.I had an MRI at our local hospital and the doctor said I have a growth in my pituitary gland, is it definitely a pituitary tumor? Do I need surgery right away?
The answer is “not necessarily”. Although the most common cause of saddle area occupancy is pituitary adenoma, it may be caused by other diseases, which requires clinical doctors to “It needs to be carefully identified by clinical doctors.
No experienced physician will diagnose a disease from a single image alone, but most of all by combining the characteristics of the patient’s case and the main symptoms, which is why we ask the patient to come in person for consultation. For example, lymphocytic pituitaryitis, which is mainly seen in women of childbearing age, is a homogeneous and diffuse lesion, and the main symptom is urinary collapse – several times more urine per day than others – a disease that does not require surgery. Another example is Rathke’s Pouch Cyst, a congenitally developing vesicle caught in the pituitary gland, which usually has no obvious clinical symptoms and does not affect normal life, and only needs to come to the hospital for regular review, unless individually it grows bigger and bigger and compresses the pituitary gland causing patients to have hypopituitarism and menstrual disorders, then it needs to be considered Surgery will be considered. There is also a disease called “hypothyroidism secondary to pituitary hyperplasia”, which is actually a condition in which the thyroid gland under our laryngeal nodes is “too lazy to work” and the pituitary gland has to push it harder and harder, resulting in it getting bigger and bigger; experienced doctors will notice Experienced doctors will notice that the patient has weakness, constipation, dry skin, edema and other signs of hypothyroidism, and avoid misdiagnosis as “pituitary adenoma”, because in this case the surgery will not relieve the condition, but will further aggravate it! Therefore, when you are examined and found to have pituitary lesions, you must go to a professional pituitary adenoma multidisciplinary comprehensive treatment center and undergo the corresponding targeted treatment after a clear diagnosis by experienced doctors; otherwise, it is likely to miss the best time for treatment, and may even aggravate the disease due to wrong treatment!
7.Do all pituitary adenomas need to be treated by surgery?
No. In addition, non-functional pituitary microadenomas less than 1 cm in diameter can be treated without surgery first, and can be followed up by regular MRI examinations to see if the tumor grows progressively before deciding whether surgery is needed. If the non-functional microadenoma does not grow, surgery is not necessary.
8. It seems that the symptoms caused by pituitary disease are more complicated than appendicitis and cholecystitis, so it is indeed easy to be overlooked or missed. What symptoms in my body may be caused by pituitary adenoma? Why didn’t I see it before?
Many diseases can have similar presentations, such as a cough – a cold can cough, so can tuberculosis, and failure to check sputum or lung films can lead to misdiagnosis or underdiagnosis. Pituitary adenomas are benign tumors that grow slowly and are insidious, so most patients do not feel the dramatic changes in their condition, and many are delayed if the hospital does not perform a thorough evaluation. In addition to the common endocrine abnormalities, there are other “telltale” signs and symptoms that can help avoid misdiagnosis and underdiagnosis.
First, because larger pituitary adenomas can cause compression of the optic cross, resulting in vision loss and visual field defects, they are easily misdiagnosed as presbyopia, cataract, glaucoma, refractive error, and other eye diseases in older patients, resulting in a series of unnecessary treatments and no improvement in symptoms, which is a cause for alarm. The visual field defect caused by pituitary adenoma is mostly manifested as “bilateral temporal hemianopia”, which is a medical term meaning that both eyes are unable to see on the outer corner of the eye, and when crossing the road, you may feel that you cannot see the cars coming from the left and right sides clearly. If the tumor growth is not completely centered, but to one side, it may cause the patient to have impaired vision in one eye.
Secondly, pituitary adenoma often causes non-specific symptoms such as reduced blood sodium level, weakness, loss of appetite, nausea, etc. If the clinician does not pay close attention to the patient’s blood electrolyte level, hormone level or saddle area MRI results, the diagnosis may be missed. For example, some patients with severe sleep apnea syndrome (OSAS) may miss the diagnosis of “sleep apnea due to pituitary growth hormone adenoma” if they do not have an MRI – you must be wondering: the impression is that the pituitary gland and the respiratory tract are simply the same. You must be wondering: How can the pituitary gland be related to the respiratory tract when it’s not even close to the same thing? In fact, this is because pituitary growth hormone adenoma will overproduce growth hormone, and growth hormone will cause hyperplasia of the throat and airway wall, resulting in poor airway, thus causing symptoms such as snoring and apnea in sleep. Obese patients with “full-moon face”, “buffalo back” and “acne” also need to be alert to the occurrence of Cushing’s disease, if they do not check hormones and rely only on dieting to lose weight, the effect is often If you do not check your hormones and rely on dieting to lose weight, the results are often poor and treatment is delayed. In short, once you have endocrine abnormalities with headache, vision loss and visual field loss, you must go to the hospital and be alert to the possibility of pituitary adenoma to avoid misdiagnosis and omission.
9.What are the risks of this surgery?
The main surgical risk is damage to the normal pituitary tissue. Even for experienced pituitary tumor surgeons, about 5-10% of patients still have postoperative hypopituitarism after removal of a large pituitary adenoma. Once the damage has occurred, it cannot be repaired and may require long-term hormone replacement therapy, including thyroid hormone, corticosteroids, growth hormone, estrogen, or testosterone. We try to be “perfect,” but there are some situations that are difficult to completely avoid, especially in tumors that are difficult to operate on and that encircle the cavernous sinus and major blood vessels. Analogous to the “surgical” precision strikes in the U.S. war on terror, even with a strong military, there will inevitably be casualties. The same is true for our surgeries, where the removal of tumors inevitably results in the loss of some normal pituitary tissue in the body, and the patient then experiences a postoperative “injury” to the pituitary gland – for example, damage to the posterior pituitary gland can result in uremia (1-2% incidence). The resulting urine is clear and colorless, and the patient experiences frequent urination and thirst, which can be replaced with synthetic antidiuretic hormones (i.e., mydriasis) with good results. In most patients, pituitary function can be partially restored after the surgical trauma and inflammation subsides, and long-term drug supplementation is not required. In addition, in most patients, after most of the anterior pituitary tissue has been removed, the remaining anterior pituitary tissue is still able to secrete enough hormones for normal body activities, so surgical injury does not mean that lifelong replacement therapy is required. In conclusion, we will try to operate as delicately as possible during surgery to avoid damaging normal pituitary tissue. However, for pituitary adenomas that are difficult to operate, the risk of postoperative hypopituitarism does objectively exist, and postoperative hormone replacement therapy is required.
10.Are there any other serious surgical complications?
Yes, there are. However, most of the surgeries do not have serious complications, but for some complicated surgeries, the physician will give you special instructions.
First of all, damage to the internal carotid arteries on both sides of the pituitary gland can cause hemorrhagic shock and death, or cerebral infarction after embolization of the vessels. However, the incidence of this is very low (about 1/1000) for an experienced surgeon. Second, postoperative bleeding into the residual tumor cavity or the pterygoid saddle can aggravate the compression of the optic nerve and optic cross, which may cause severe visual field defects and vision loss. This is a very rare complication that requires reoperation to remove the clot and relieve the compression symptoms. Third, since the pituitary tumor is separated from the cerebrospinal fluid by only a membrane, there is a possibility of cerebrospinal fluid leakage after surgery. In order to repair the broken membrane and prevent intracranial infection secondary to cerebrospinal fluid leakage, a small piece of adipose tissue and fascia taken from the patient’s own body is usually filled in the tumor bed during surgery to play a role of physical reinforcement. Nevertheless, the incidence of postoperative cerebrospinal fluid leakage is still about 1%, and for giant adenomas and craniopharyngiomas that break through the saddle and septum, the incidence of cerebrospinal fluid leakage is even higher, and when it occurs, there is a risk of infection secondary to meningitis, which may require two or even three surgeries to repair the cerebrospinal fluid leakage.
The rates we mentioned above are for experienced surgeons, but for inexperienced operators, the rates of all the above complications will be higher.
11. How long will this surgery last and approximately how long can I be discharged after the surgery?
The entire procedure, including anesthesia and awakening, usually lasts 3 hours. In foreign countries, patients are usually observed in the neurosurgical care unit for 2-3 hours after the operation, and then they are discharged from the ICU, and domestic patients are usually discharged the next morning. Most of the patients abroad will be discharged 1-2 days after surgery, but at Concordia, out of caution, they are usually observed for a few more days after surgery, and can be discharged as early as 3 days.
12.How will I feel after surgery?
You may feel the common “sinus headache” and nasal congestion, and you may also find yourself “out of breath” and unable to smell – but these symptoms usually resolve themselves in a few weeks as you recover from surgery. These symptoms usually resolve themselves after a few weeks as you recover from surgery, so you don’t need to worry too much. If you are unsure, you can take medications to relieve the congestion, such as mint nasal drops and furosemide nasal drops, which are often effective in China. In addition, patients will generally feel fatigue after surgery, which usually will gradually ease after 2-3 weeks.
13.I have been recovering well after surgery and have been discharged home for several days, but today I suddenly felt panicky, weak and uncomfortable everywhere. I went to the community health office, but the doctor couldn’t tell me what the problem was, but I felt so uncomfortable. Doctor, what is going on and what should I do?
For the patient, pituitary adenoma removal is an operation that involves only part of the body structure (the head); however, for the small pituitary gland, it is a major operation that “involves the whole body”! The post-operative pituitary gland is like a “sister of the forest” recovering from a serious illness, with disturbances in various physiological functions and fluctuations in various hormone levels, including a significant decrease in the secretion of the posterior pituitary (pituitary) hormone, ADH.
What does this mean? If you think about what “antidiuretic hormone” does, it is to resist diuretic factors, promote urination, and overproduction can even lead to urinary collapse. After pituitary adenoma resection, the secretion of antidiuretic hormone decreases and postoperative urolysis occurs, and the body loses a large amount of sodium with urine. It causes serious disturbance to the normal functions of the circulatory, skeletal and nervous systems of the whole body, and the patient therefore appears to be “unwell everywhere”. The most important thing to do at this time is to go to the nearest emergency hospital to have your blood electrolyte levels checked, and be sure to inform your physician of your history of pituitary surgery.
During the period of discomfort, the patient may limit the amount of water consumed and eat salty foods to supplement sodium loss. If hyponatremia is confirmed, the physician will give the patient oral hormone replacement therapy and symptomatic support therapy depending on some common causes, such as hypoadrenocorticism or inappropriate secretion of antidiuretic hormone syndrome.
Patients need to be reminded here that although postoperative hyponatremia can be relieved by symptomatic support and the recurrence rate is low, it is still important to visit a regular hospital! There are two main concerns: first, severe electrolyte disturbance can trigger cardiac arrhythmias and bring about clinical crisis; second, too rapid an infusion of intravenous supplemental saline may cause neurological complications such as myelinolysis, leading to irreversible damage. Therefore, the first priority of patients is to be alert to the occurrence of the above-mentioned symptoms and seek timely medical attention to avoid delaying the disease.
14.How long do I need to take off work and rest?
It depends on your job. On average, you can return to normal work in 2 weeks abroad, and most patients at Concordia are able to start normal work about 2 weeks to 1 month after surgery.
15.Do you have any requirements for my diet before and after surgery, doctor? I have had diabetes/hypertension for more than 10 years, is there anything I should pay special attention to this disease? How should I pay attention to diet control?
That’s very nice of you to take that into consideration! Your physical condition has a great impact on the outcome of your surgery, and maintaining stable blood sugar and blood pressure levels is essential for a smooth surgical procedure. This is because patients with pituitary adenoma combined with hypertension have a significantly higher risk of intraoperative stroke and heart failure than the average patient, and nasal bleeding during surgery can increase significantly and affect the surgical field. Therefore, tighter blood pressure control is needed in the perioperative period, with a goal of 140/90 mmHg or less in general patients and 130/80 mmHg or less in diabetic patients. Patients with Cushing’s syndrome and acromegaly have very difficult blood pressure and blood glucose control. We will ask the endocrinology department to assist in the diagnosis and treatment of your disease, which also requires you to cooperate with the treatment in all aspects, otherwise the surgery needs to be postponed. Some patients only use oral hypoglycemic drugs to control blood glucose before surgery, but insulin is required to control blood glucose in the perioperative period, which will not make you permanently dependent on insulin, so please do not worry. Patients with pituitary adenoma combined with diabetes and hypertension are a high-risk group that requires focused care for anesthesia and surgery, and we will work together to protect you.
Therefore, during the period before and after surgery, please make sure you follow your doctor’s instructions: if you have hypertension, please make sure you maintain a low salt and low fat diet, reduce the intake of fatty and cholesterol foods (no pickled foods, fatty meats, egg yolks, instant noodles, etc.), and avoid alcohol. After surgery, you can eat potassium-rich fruits and vegetables such as oranges and pumpkin to help replenish electrolytes, and vitamin-rich foods to help with wound healing (vitamin C is needed!) and nerve function. –You may think that post-operative patients should be “bed-ridden”, but this is not a good idea. Patients should be encouraged to move around as soon as their wounds and physical condition allow (be sure to consult your doctor about this!) Patients should be encouraged to get off the floor as soon as their wounds and physical condition allow (be sure to consult your doctor!), because prolonged bed rest can lead to lower extremity venous thrombosis in diabetic or elderly patients.
16.After the surgery, am I completely well and don’t need to come to the hospital anymore?
In fact, the successful completion of the surgery is only the first step of our long journey, and the regular review after the surgery is also a very important part. We work together with all the doctors, nurses, patients and families to get rid of the common enemy of pituitary tumor. However, as the saying goes, “it is easy to fight, but difficult to defend”, we have to keep an eye on when it will come back, which reminds us of the importance of regular review. Generally speaking, we recommend to come to the clinic for review 3 months and 6 months after surgery. There are two main areas of review: blood sampling and pituitary enhancement MRI. The main purpose of blood sampling is to check the levels of various hormones and electrolytes in our blood, and their abnormalities can indicate the possibility of hypofunction or recurrence, which needs to be dealt with in time. During the initial review, the doctor will also communicate with the patient about the next step of treatment and plan according to the surgical resection, especially some giant adenomas need further radiotherapy and chemotherapy after surgery, so we suggest the patient to come to the review in person, the idea that you don’t need to worry after surgery is wrong. Once we find any signs of tumor recurrence during the review, we can make early intervention or treatment to nip the enemy in the bud! Especially, this first review in the third month after surgery is the most important! Of course, after 3 consecutive reviews, if the condition is stable, you only need to come to the hospital for outpatient review once a year. But always remember: the “enemy” may come back at any time, regular review, the alarm is always ringing!
17.If I choose surgery to treat pituitary tumor, what are the chances that I will be cured after surgery?
It depends on the type, size and location of the tumor as well as the experience of the surgeon.
For an experienced surgeon, the surgical cure rate for patients with Cushing’s disease (generally microadenomas) is generally around 90%; patients with acromegaly (generally huge, more aggressive tumors) are often difficult to cure through surgery, and even if the highest level of physician performs the surgery, the post-operative glucose growth hormone inhibition test for giant pituitary adenomas that secrete growth hormone can achieve normal inhibition Even if the highest level of physicians perform surgery, only about 60% of growth hormone-secreting pituitary giant adenomas achieve normal suppression in postoperative glucose growth hormone suppression tests. This is similar for non-functional pituitary macroadenomas. Whether a giant pituitary adenoma can be completely resected depends on whether it has invaded the cavernous sinus or the bones of the skull base. If these “minefields” have not yet been invaded, there is a greater chance of surgical cure; if they have invaded “blind spots” or relatively dangerous “minefields” that cannot be reached surgically, then If the “blind spot” or relatively dangerous “minefield” is already invaded, then the surgery cannot cure it completely. You may ask: If surgery is not curable in these cases, why do neurosurgeons still recommend pituitary giant adenoma resection? This is because the continued growth of a giant pituitary adenoma can cause compression of the surrounding vital structures (occupancy effect) and even permanent neurological dysfunction. At the same time, after surgical removal of the tumor, postoperative radiotherapy can also reduce the target range and radiation dose, bringing less side effects.
18.After the surgery, how can I know whether the tumor is clean or not? Will there be any residue?
For functional pituitary adenomas (manifested as Cushing’s disease, acromegaly and prolactinoma), the blood and urine hormone test results a few days and weeks after surgery can give us the answer.
For non-functional tumors, MRI of the saddle area can help us verify the tumor removal. In some large pituitary tumor centers, such as the neurosurgery department of Peking Union Medical College Hospital, we have introduced professional intra-operative MRI equipment in our operating room to evaluate the tumor resection of patients with giant pituitary adenoma before the surgery is finished, and if there is any residual, we can continue resection according to the intra-operative imaging structure to avoid incomplete resection or the need for secondary surgery. The surgeon can assess the removal of the tumor before the end of the surgery. Because the surgeon can only operate from the center of the tumor, it is sometimes difficult for the surgeon to determine the boundaries and size of the residual tumor during traditional surgery. However, the application of intraoperative magnetic resonance equipment and intraoperative navigation technology has brought us a new dawn, allowing us to observe whether the tumor has been resected before closing the surgical incision by MRI and to clarify the site of the residual lesion under navigation. However, for huge pituitary adenomas invading the cavernous sinus region, even with the aid of intraoperative MRI, it is difficult to achieve complete resection (see question 4 for specific reasons). To avoid serious complications, we often have to perform palliative resection (partial resection) and then usually review MRI at 6 weeks postoperatively to help us decide whether further surgery or radiotherapy is needed.
19.What should I do if I find any tumor residue after resection? Do I have to undergo radiation therapy? I heard that there are a lot of side effects and I am worried!
If there is a significant volume of non-functional pituitary adenoma remaining after transsphenoidal approach surgery, radiotherapy can be used to stop the further growth of the residual tumor, and many different radiotherapy modalities have been developed to treat pituitary tumors, including Gamma Knife and 3D conformal intensity modulated radiotherapy to minimize the side effects of radiotherapy on normal tissues. The radiotherapy department at Peking Union Medical College Hospital has the leading equipment in China for this purpose and is able to achieve better treatment results.
If only a very small part of the residual tumor is found after