PITUITARY MACROADENOMA

I was recently diagnosed with a pituitary macroadenoma, but seem to be having a difficult time getting much information out of my neurologist. I recently asked the ENT specialist I had an appointment with some questions and got "a few" of my questions answered. I finally just asked for the MRI report so I could try to learn a little more about my condition on my own. It reads as follows:   A bulky mass is seen within the sella, with prominent extension into the left cavernous sinus.This is 1.5cm in height and sagittal diameter and 2.8cm transversely. Suprasellar extension is seen with pituitary stalk deviated to the right, although the mass extends through the full width of both the left and right side of the pituitary. On the left there is gross extention into the cavernous sinus, with extensive contact with the left internal carotid artery, which is inferiorly displaced.Outward bulging of the dura overlying the cavernous sinus, additional bulging of the mass into Meckel's cave. No contact, compression or displacement of the optic nerves.  

To me this sounds really serious, but with my limited medical knowledge, I have no idea if it is or not. The neurologist feels this should be taken care of surgically and the ENT doc agrees, but says it may be tricky to remove all of it through the nose. Surgery is scheduled for the 27th of this month. Does it sound like surgery is my best option? I am having frequent headaches, dizziness, tingling in my face and slight problems with consentration, though I'm not sure if the pituitary has anything to do with consentration. Are there any specific things I should be asking my neurologist about or informing him of?

[enzymelover]

   Unfortunately, surgery is the best choice for a mass of this size, and it is true that it could be tricky to remove the entire mass through the nose, due to the extension into the cavernous sinus and the contact with the carotid artery. You may need two surgeries to get it all, and your surgeon may recommend a craniotomy for the second one.

I have been reading a lot about pituitary surgery for a couple of weeks. My son will have to have this surgery too in the near future.
It is good there is no compression of the optic nerves. If your only symptoms are dizziness, headaches and facial tingling, you are very lucky actually. Usually, it is vision loss that causes people to seek medical care, leading to finding the tumor. My son has severe pituitary hormone loss, and a large number of problems as a result.

You may have temporary hypopituitarism after the surgery, but most people have a very good outcome from the surgery, especially if it is the endoscopic nasal approach. It is very important however that you have a very skilled pituitary surgeon, with lots of experience.

[rumpled]

The sella is where the pituitary sits.
The cavernous sinus is where all the nerves and blood vessels are to the side and below.
Your stalk deviating to the right shows it is being pushed.

You need to contact the very best surgeons around. Do not mess around.
The mass in the cavernous sinus can only be reduced, probably, with radiation. You will have to investigate the different kinds and decide what is best - that area cannot be operated on.

The part around the carotid will be tricky too.

They will likely try to debulk it and then go for radiation.

Are you having any hormonal deficits right now?

[rumpled]

Your surgeon's experience will influence the outcome of your surgery. This goes for small tumors too - but with large tumors, it can be so more dangerous with the carotids involved as they have to know where they are instead of a silly slip.

You must have the best. Even if you cannot afford to travel, airlines will give free flights if you are going to a hospital (to you and a companion) through programs, just look for them, and get to where you need to go.

[lalaoooo]

i wanna know if u survived ur operation...my father was diagnosed the same...pituitary tumor and the doctor recommended to undergo surgery asap. we dont have any knowledge about it..so i found ur site...i just wanna know the chances and ur experience handling these.....please reply...thanks...lala

[rumpled]

Pituitary surgery with an EXPERIENCED surgeon (note emphasis) has little risk of mortality. Surgeons that don't have experience can have more of a chance of stroke or blindness complications. Most of the other risks are associated with anesthesia.

What type of tumor does your dad have, and what size? All those are factors as well (larger ones can be wrapped around different things, and some tumors are softer).

Also, some types can be reduced with medication. Is your dad at a pituitary center, under the care of a neuro-endo? And is he getting copies of everything - MRI reports and testing?