After pituitary tumor surgery, patients are very concerned about what the results will be and whether the tiny pituitary gland will be injured. Let’s start with the results. The extent to which surgery can relieve pituitary tumor symptoms is related to the nature of the tumor and the extent of resection. For functional pituitary tumors, if the tumor is not completely removed, the residual tumor cells will still secrete relevant hormones after surgery, for example, the residual cells of lactogenic pituitary tumors will still secrete prolactin, resulting in feminization in male patients and menopause and lactation in female patients, and growth hormone pituitary tumors, the residual cells of which will still secrete In the case of growth hormone pituitary tumors, the residual cells still secrete growth hormone, and the symptoms of preoperative acromegaly and ugly appearance still cannot be relieved. Therefore, for functional tumors, only total excision can completely improve the symptoms. (See the figure below) For non-functional pituitary tumor, due to the occupying effect of the tumor, it causes headache due to increased tension in the pterygoid saddle, or vision loss and visual field loss due to compression of the optic nerve. Therefore, we should also strive for total excision of this non-functional tumor. If the pituitary tumor is cleanly cut, the symptoms of tumor compression will be improved soon. Of course, there are some pituitary tumors in special locations, such as in the lower part of the optic thalamus or the third ventricle (see below), and it may not be possible to cut the tumor cleanly in one operation via nasal endoscopy. Once the tumor in the lower part of the optic thalamus or the third ventricle collapses or grows again, another surgery will be required, which is like a river ditch that is too wide, so one step is too wide and two or even three steps are required. However, the principle of surgery is: if transnasal surgery is performed, endoscopy must be chosen instead of microscope, and only traditional craniotomy can use microscope. If the endoscope is used in transnasal surgery, it is like a person standing at the door of a room and observing what is in the room, while using the microscope becomes a person standing at the end of the corridor and looking at what is in the room at the end of the corridor. Regarding the question of whether it will cause postoperative hypopituitarism, in fact, if the surgery completely separates the tumor from the pituitary gland and does not injure the pituitary gland itself, it will not cause postoperative hypopituitarism. However, whether complete separation can be achieved is still related to the location of the pituitary gland, the texture of the tumor and the operating technique and experience of the surgeon. Then the surgeon will scrape the tumor several times during the separation process and try to achieve complete excision. When the doctor repeatedly scrapes off the tumor cells, it is inevitable that the pituitary gland will be injured indirectly, which will easily lead to uveitis after surgery. However, few patients will develop intractable uremia, which usually can be relieved by taking desmopressin tablets (e.g., Meadin) for a few weeks to a few months after surgery. If a patient has been on injections and medication for 1 to 2 years or more and still has not been able to get relief from uremia, it means that there was a pituitary stalk break during the surgery, resulting in a disruption of the entire endocrine system. However, this condition is very rare. Since pituitary tumors are adjacent to the optic nerve, some patients may also damage the optic nerve due to blurred vision from tumor bleeding during surgery, or bleeding from rupture of the tiny suprasellar artery, resulting in more severe postoperative vision loss or even blindness, as well as severe headache. Therefore, if the patient has a sharp loss of vision or more severe headache within 48 hours after surgery, it is possible that another surgery is needed to do optic nerve decompression, remove the hematoma, and cut the residual tumor clean. This article is authorized by Dr. Guo Hongchuan. Click on the related link for more details of “Pituitary Tumor: Surgery or Medication? After pituitary tumor surgery, watch out for cerebrospinal fluid nasal leakage and intracranial infection.