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Sunday 16 June 2019
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Pituitary Surgery

The Pituitary surgical service in Manchester is one of the busiest in the country, serving a population of approximately 3.5 million adults and 5 million children. Pituitary surgery is undertaken at both Salford Royal (Adults) and the Royal Manchester Children’s hospitals (Paediatrics/Children).  We also accept and treat patients referred from outside of the Manchester region, including overseas patients.

 

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Pituitary gland location
Pituitary gland location within the brain

Types of pituitary problems

The pituitary gland is the ‘master’ endocrine organ, which is situated at the base of the brain, at the back of the nasal passages.

 

Although 10-20% of the general population may possess a pituitary lesion most of these remain small and do not cause symptoms. However, a small proportion progress to cause major neurological (especially visual impairment) and hormonal symptoms such as Acromegaly and Cushing’s disease.

 

The majority of pituitary tumours are benign (not cancer) and the patients respond well with treatment which includes surgery, medical and radiation therapies.   Most pituitary tumours are adenomas, although a variety of pathologies can be encountered around the pituitary gland requiring surgical intervention, including:

  • Craniopharyngiomas

  • Pituitary apoplexy

  • Inflammatory disease of Pituitary (eg Lymphocytic hypophysitis)

  • Infection of Pituitary (eg Tuberculosis)

  • Cystic lesions (eg Rathke’s cyst)

  • Meningiomas of anterior skull base

  • Metastasis

  • Bony tumours (eg Chordomas, E & fibrous dysplasia)

  • Meningoencephalocoeles

  • CSF leaks of anterior skull base

 

Types of pituitary surgery

Pituitary surgery can be undertaken in a variety of ways and these are described below.

 

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Cranial approaches
Types of surgery - cranial approaches

Cranial approaches

A variety of cranial approaches (eg frontal and pterional) have been described, but the eyebrow approach is less traumatic and is generally the preferred cranial approach.  However these traditional operations through the skull (craniotomy - I) are far less common nowadays and are only used when the simpler approaches through the nose (II) are thought to be unsuitable.

 

Through the nose - endoscopic surgery

Most operations on the pituitary gland in Manchester are now carried out through the nose. This is called trans-sphenoidal surgery. ‘Trans’ means 'across' and the ‘sphenoid sinus’ is the air cavity in which the pituitary gland sits.

 

Trans-sphenoidal surgery can be undertaken in the traditional manner using a microscope and nasal retractors, or more recently using endoscopic techniques.

 

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Endoscopic approach
Endoscopic approach

With the endoscopic approach, a small fibre optic endoscope is passed through the nose to look at the pituitary region.  The endoscopes have wide-angled panoramic views, which also allow the surgeon to look around corners. 

 

This method is less traumatic to the patient, with faster recovery times as the technique also avoids nasal packing. The optical advantages of the endoscope and the ability to look within the tumour cavity may help to improve tumour removal. This approach is also used to tackle some of the anterior skull base tumours in conjunction with the Skull Base team.

 

Research and Teaching

Manchester has a growing national and international reputation for both basic science and clinical research in Pituitary pathology, with numerous publications and presentations. Our surgeons also take part in teaching workshops and offer fellowships for visiting surgeons wishing to learn pioneering techniques in Pituitary surgery.

 

The Surgical Team

Pituitary surgery in Manchester is undertaken by the Neurosurgeons, Mr Kanna Gnanalingham and Mrs Konstantina Karabatsou.

 

As part of a multi-disciplinary team (MDT), the pituitary surgeons work closely with the endocrinologists across the Greater Manchester region. Other key members of the team include the Oncologists, Neuroradiologists, Neuro-ophthalmologists, and the Specialist Nurses. All surgical patients are discussed on a regular basis at the Manchester Pituitary MDT meeting, in accordance with NICE guidelines.

 

Patient Information Leaflets 

Below is a list of all our leaflets which relate to Pituitary  tumors - if you want to view all available leaflets please visit the patient leaflet section.

 

Pituitary Leaflets