Indications for surgery

The main indications for surgery on the pituitary are either uncontrolled symptoms from an endocrinologically active tumour, or from symptoms associated with pressure on surrounding anatomical relations. The surrounding relations and the signs and symptoms are listed below.

• Visual pathways - interference with these pathways will result in visual disturbances
• The cavernous sinus - this are houses cranial nerves (III, IV & VI) which are important in eye movements
• The meninges - pressure on the meninges usually presents with headache
• The third ventricle - pressure on the ventricles can lead to interuption of the flow of cerebrospinal fluid (CSF) and can lead to hydrocephalus
• The hypothalamus - any damage to the hypothalamus can manifest in a number of different ways from altered thirst to precocious puberty
• The sphenoid sinus - downward extension of the tumour into the sphenoid sinus can lead to CSF leaks and nasal obstruction.