Surgical treatment of acromegaly

Surgical procedures used today are very sophisticated and a neurosurgeon who specialises in removing pituitary tumours will carry out your operation. This type of surgery is always performed under general anaesthesia, which means that you will be put to sleep by an anaesthetist before the procedure.

The vast majority of procedures will be carried out through the nose of the patient as this is the most direct way to access the pituitary gland. Doing the operation this way means that there is no visible scarring and your stay in hospital is shorter. The operation will normally take about 1 to 2 hours and you will be in hospital for about 5–7 days in total.

Surgery can be performed either as a micro-neurosurgical or an endoscopic procedure. The method used depends on the preference of the surgeon who carries out the operation. In experienced hands, both will yield equally good results.

During the surgery the neurosurgeon will make a small cut in the back of the wall of your nose or mouth (this is transsphenoidal surgery) so that he or she can see to remove the tumour in the pituitary gland.

Very occasionally an operation through the skull (transcranial surgery) may need to be done instead.

Whether it is possible to completely remove the tumour and restore growth hormone levels to normal depends on the size and position of the tumour.

If the tumour is small and completely accessible, surgery alone may be successful and no further treatment will be required.

No surgery is without risks. Your surgeon will advise you about the possible complications that sometimes occur from the surgery.

Sometimes the operation may damage other parts of the pituitary gland which may affect the production of other hormones. If this occurs, your doctor may prescribe replacement hormone therapy for you.

You may experience side effects from the general anaesthetic such as feeling sick after surgery, a sore throat or stuffy nose and headache. Pain relieving and other medications will be given to you to ease these temporary symptoms. You may also feel very tired after the surgery.

It is important to let your doctor know immediately if you feel unwell for any reason in the first few weeks after your operation. It is especially important to let your doctor know if you have severe headaches or notice clear fluid coming down one or both nostrils.

Clear fluid dripping from your nostrils may be due to a cerebrospinal fluid (CSF) leak. CSF is the liquid around your brain and spinal cord. It is possible for CSF to leak through the nose if the cut made during surgery doesn’t heal properly. Further surgery may be required to repair the leak. This side effect can occur years after surgery, as in Maria’s case highlighted below.