A Full Range Of Options In Minimally Invasive Pituitary Surgery

Precision from Innovation and Collaboration

Providing a full range of options in minimally invasive pituitary surgery

The treatment of pituitary adenomas has evolved tremendously because of recent advances in emerging technologies such as the endoscope, surgical microscope and image guidance systems, coupled with an increased focus on multidisciplinary collaboration.

“These new technologies enable us to perform minimally invasive pituitary surgery that allows for precise removal of tumors in or around the pituitary gland,” says Warren R. Selman, MD, Neurosurgeon-in-Chief, University Hospitals; Director, UH Neurological Institute, Neurosurgeon in Chief, University Hospitals Case Medical Center; and the Harvey Huntington Brown Jr. Professor and Chair, Department of Neurological Surgery, Case Western Reserve University School of Medicine. “This approach benefits patients in a number of ways, including complete tumor removal, faster recoveries, little or no scarring, and fewer complications. Plus, the pituitary function remains intact.”

At UH Neurological Institute, patients also benefit from highly specialized care plans that offer a variety of treatment options ranging from endoscopic and microsurgical procedures to non-invasive treatments with Gamma Knife and Cyberknife. A multidisciplinary team of neurosurgeons, endocrinologists, otolaryngologists, radiation oncologists, neuro-oncologists, medical oncologists, interventional radiologists and other specialists consider all treatment options before collaborating to devise customized care plans tailored to the patient’s needs.

Reducing Morbidity

In the past treatment of pituitary adenomas required a craniotomy. “Before minimally invasive procedures were available, patients had few options and little chance of a cure, so in effect they revolutionized treatment of pituitary adenomas and other lesions of the anterior skull base,” Dr. Selman explains.

“One of the most extraordinary advances is the minimally invasive, fully endoscopic approach,” says Chad A. Zender, MD, FACS, Department of Otolaryngology – Head and Neck Surgery, University Hospitals Case Medical Center; and Assistant Professor, Department of Otolaryngology, Case Western Reserve University School of Medicine. “Although this technique is commonly used to remove nasal polyps and treat sinus disorders, few centers use it routinely to treat complex tumors of the anterior skull, such as pituitary adenomas and meningiomas.”

This innovative procedure employs a tiny endoscope, 3 to 4 millimeters wide and 20 centimeters long, with angled tips, that is inserted through the nostril and up to the sphenoid sinus. New imaging technology produces high-definition, three-dimensional images that can be magnified for the surgeon and displayed on multiple monitors. Image guidance provides for precise localization, instrument placement and tumor resection. “These procedures are always performed by a team, with the ear, nose and throat specialists guiding with the endoscopes and the neurosurgeons working to remove the tumor from the pituitary fossa or skull base,” Dr. Selman says. “As a result, cooperation between the neurosurgeon and the head and neck surgeon is paramount.”

An endoscopic approach allows for complete surgical resection of pituitary adenomas, avoiding a craniotomy and requiring no retraction of the frontal lobes, Dr. Selman points out. “Procedures that previously required a skin incision and craniotomy are no longer the only option, because the endoscope allows access for instruments to work in very narrow corridors.”

An Adjunct to Open Approaches

Stereotactic image guidance is frequently used as a supplement in endoscopic cases. “While it’s not a substitute for surgeon experience or anatomical knowledge of the paranasal sinuses and anterior skull base, it is a useful adjunct,” says Dr. Selman. “Both volumetric MRI and CT can aid the surgeon by helping to delineate distorted landmarks and map out tumor locations. MRI does an excellent job of helping to differentiate between normal soft tissue and tumor, while CT scanning is best at helping identify bony landmarks.”

“Thanks to these technological advances and a highly specialized multidisciplinary approach, the UH team members from the UH Neurological Institute and UH Ear Nose and Throat Institute have found that they can use the endoscopic approach or the treatment of a wide variety of conditions located near the anterior skull base.”