Surgery Q&A - April 21
See below for highlights from our #PitHour about surgery on 21st Apr 2021. All tweets can be found by searching #PitHour on Twitter.
We have also listed lots of useful surgery resources at the bottom of this page if your question is not answered here
Question 1
My question is what I should prefer after a failed pit surgery in february. I am not healed for cushings and wonder what is the best: 2nd surgery og gammaknife?
— Gunnvor H Leonsen (@Gleonsen) April 21, 2021
Answer 1
#pithour It depends on how difficult the initial surgery was. If your surgeon feels that second surgery has a good chance of remission then I'd favour that. Gamma knife is a good alternative otherwise if there is a clear target. Medical therapies can also be considered.
— SheffNeuroSurg (@sheffneurosurg) April 21, 2021
#PitHour Really important to be guided by your multidisciplinary team inc. your neurosurgeon and endocrinologist. Depends on your individual case - microadenoma or macroadenoma, whether it involves critical structures (e.g cavernous sinus), if it is a clear target on scan etc etc
— Omar Pathmanaban (@brain_op) April 21, 2021
Question 2
#pithour what would be the most common side effects following Pituitary surgery?
— eflo29 (@eflo291) April 21, 2021
Answer 2
#pithour most common - blocked nose leading to very dry mouth, headaches and pituitary dysfunction. All pituitary surgery carries risks of infection, CSF (brain & spine fluid) leak, stroke and a small risk to life. Thankfully these are much rarer.
— SheffNeuroSurg (@sheffneurosurg) April 21, 2021
Sometimes sodium and issues passing too much urine. Hormone effects depend on size of tumour
— Helen Simpson (@hormone_doc) April 21, 2021
Question 3
#PitHour my question is if your first surgery was not successful can you ask for a different surgeon & hospital even out of area on NHS please
— Tranquil-life (@lifetranquil1) April 21, 2021
Answer 3
#pithour Yes
— SheffNeuroSurg (@sheffneurosurg) April 21, 2021
#PitHour you can ask your GP to make a referral or discuss with your current pituitary team - endocrinologist and/or surgeon
— Omar Pathmanaban (@brain_op) April 21, 2021
Question 4
Forgive my ignorance, very new to this. Is a patient able to choose if surgery is Trans-sphenoidal or via the head, or is this solely determined by the size of the tumor please? #PitHour
— Rachel Yeeles (@RachelYeeles) April 21, 2021
Answer 4
#PitHour most pituitary tumours are best treated via the nose (transsphenoidal). A small proportion are treated with a craniotomy (via the head) or both. You can discuss the pros and cons with your surgeon and share the decision with all the information on your individual case
— Omar Pathmanaban (@brain_op) April 21, 2021
Question 5
#pithour are all types of pituitary radiation the same?
— eflo29 (@eflo291) April 21, 2021
Answer 5
#PitHour The end goal is the same, but different ways of doing it - one single shot (Radiosurgery) or divided over a number of shots (fractionated radiotherapy) depending on your particular tumour configuration & its relationship to important things like your optic nerves etc
— Omar Pathmanaban (@brain_op) April 21, 2021
Question 6
#PitHour how long would you expect to be in hospital after pituitary surgery with Cushing's?
— Helen Fox (@HelsbelsFoxie) April 21, 2021
Answer 6
#PitHour important to know that often you feel worse when surgery has been successful at inducing remission of Cushing’s because your body is used to being soaked in excessive steroids and it suddenly gets turned off. Sometimes feeling awful at first is a reason to celebrate!
— Omar Pathmanaban (@brain_op) April 21, 2021
Question 7
#pithour do all pituitary tumours require surgery?
— eflo29 (@eflo291) April 21, 2021
Answer 7
#pithour No. Prolactinomas are usually managed with medication. Small tumours with no associated symptoms are usually just followed up with scans. Whilst you might not need a surgeon you do need to be under an endocrinology team - doctors & nurses.
— SheffNeuroSurg (@sheffneurosurg) April 21, 2021
Question 8
#PitHour Have I understood correctly... the size of a pit tumor doesnt tell the possible damage? A 1 mm tumor can cause the same amount of heathissues as a 9 mm??
— Gunnvor H Leonsen (@Gleonsen) April 21, 2021
Answer 8
#pithour The risks of pituitary surgery are similar - I actually find surgery on very small tumours much more difficult. Interesting to see what @brain_op thinks?
— SheffNeuroSurg (@sheffneurosurg) April 21, 2021
#PitHour I agree @sheffneurosurg the very small and the very big tumours typically pose the most challenges and the ones in between are often less technically difficult for the pituitary surgeon
— Omar Pathmanaban (@brain_op) April 21, 2021
Surgery resources:
- Pituitary Surgery & Radiotherapy booklet - An overview of surgical and radiotherapy treatments, when they might needed and what to expect
- Preparing for Surgery Fact Sheet - Questions to ask your endo and surgical teams before surgery
- Post-Surgery Fact Sheet - What to expect when recovering from pituitary surgery
- Surgery Q&A video with Saurabh Sinha (Part 1 & Part 2) - Neurosurgeon Saurabh Sinha answers questions sent in from our patient community
- Surgery for Pituitary Tumours - Saurabh Sinha's session from our Virtual Conference outlines the different types of pituitary surgery and how and when they may be used
