recurrent pituitary tumour

I am a 54 year old male. I was operated through trans nasal route for a 3 cm pituitary tumour in Aug 2007 and again in Dec 2007 for a residual pituitary tumour which bthe operating neurosurgeon confessed he could not remove completely.. My bi temporal hemianopias had regressed over the next one year. But I I had a MRI done yesterday and it showed again a large 2 by 3 cm pituitary macroadenoma. I think it is the same residual tumour. What is the best way of dealing for the third time whether trans cranially or through the trans nasal route again. What is the role of gamma knife  surgery now? I have not developed hemianopias yet but the radiologist says that the tumour is pressing up on the optic chiasma.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

I am not a neurosurgeon but rather a neurologist, and have limited surgical knowledge, so your question may be better answered if there is a neurosurgical forum, I will provide you with what little knowledge I have on this subject.

Pituitary tumors, as you may know, are usually benign, but cause problems due to compression on surrounding structures such as the optic nerves (leading to bitemporal hemianopia as in your case), and other symptoms depending on the size of the tumor and its growth pattern. If a pituitary tumor is secreting specific hormones (specifically prolactin) it can be shrunken with medications, but often, surgical treatment is necessary. If the tumor is not fully removed (as sometimes is the case particularly when there are structures that need to spared such as the optic nerve) residual tumor can certainly re-grow. The best surgical approach depends on the pattern in which the tumor is growing (whether or not it is invading into surrounding tissue for example; this is very unlikely with pituitary adenomas though), if there is scar tissue from the prior surgery, what the extent of vision involvement is, and other surgical factors. Radiation is typically avoided when possible for pituitary adenomas because the radiation can damage the optic nerves, leading to vision loss, but it is certainly sometimes used, and a combination of both surgery and gamma knife can be used as well. Discussion of your treatment options with your neurosurgeon is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.