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June 5, 2023

Innovations in Endoscopic Surgery for Pituitary Tumors

by Daniel F. Kelly

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Named among the nation’s top neurology and neurosurgery centers, experts at Pacific Neuroscience Institute® (PNI) are at the forefront of research in the advancement of treatment and follow-up care. Daniel F. Kelly, MD, Co-Founder of PNI and a multiple recipient of the Southern California Super Doctors Distinction, discusses innovations in pituitary and brain surgery treatment.

Innovations in neurosurgery have not only improved patient outcomes but drastically changed the surgical field. In the past 15 years alone, we have seen a shift from metastatic melanoma being the most common malignant brain tumor, to now being one of the least common due to targeted therapies and immunotherapies. 

Today, with the help of endoscopic surgery, neurosurgeons can perform microsurgeries better than ever before, particularly those involved with the pituitary gland.

What is the pituitary gland?

The pituitary gland, or master gland, controls all of the body’s hormonal functions. It is very small and is surrounded by a unique set of structures, including the carotid arteries, optic nerves, and the nearby brainstem. It’s a very compact, amazing area, and unfortunately, a lot of tumors arise there. For our patients, fortunately, these tumors are very removable and mostly benign.

What is the most common type of pituitary tumor?

Although there are rare types of pituitary tumors, such as craniopharyngiomas and chordomas of the skull base, over 80% of pituitary tumors are pituitary adenomas, which are treated through the nose by endoscopic endonasal surgery. For these patients, most are in the hospital for one night and go home the next day. 

Can pituitary tumors be treated with medication? 

Prolactinomas are the only subset of pituitary tumors that are treated through medication. Using a drug called dopamine agonist, prolactinomas typically shrink through medication and do not require surgery. 

However, pituitary medicine is a multidisciplinary team approach and has come a long way. At PNI, we have a Center of Excellence team approach that allows a patient with a pituitary tumor to see an endocrinologist regarding their hormones, a neuro-opthalmologist for their vision, and a surgeon to remove the tumor, all in one day. This multidisciplinary care under one roof and collaboration is ideal for our patients.

How are pituitary tumors diagnosed?

Many patients with a pituitary tumor are referred by an ophthalmologist, primary care doctor, or endocrinologist. If they come in with a functional tumor, such as Cushing’s disease, which happens when there is too much cortisol in the blood, or acromegaly, which happens when there is too much growth hormone, the first thing that we do is make sure that the diagnosis is correct.

Pituitary tumor diagnosis
Garni Barkhoudarian, MD, with a patient.

Depending on the size and location, the patient may be recommended as a candidate for endoscopic endonasal surgery. Before the surgery, the patient will be debriefed on the procedure. 

How are pituitary tumors discovered?

Most brain and pituitary tumors are discovered incidentally by an unrelated scan that reveals the brain tumor.

How is pituitary surgery performed?

Pituitary surgery is performed using a thin tube with a camera and light source called an endoscope. The angled lens of the endoscope goes inside the nasal cavity to the sphenoid sinus, allowing surgeons to see a panoramic view of the brain rather than the tunnel vision of the microscope.

What is the recovery time from endoscopic surgery?

Endoscopic surgery allows surgeons to remove a tumor without refraction, getting patients through surgery easier and with minimal collateral damage. At PNI, we have the shortest length of stay within all 51 Providence hospitals, with patients recovering from brain tumor surgery within one or two days.

two doctors performing a surgery
Daniel Kelly, MD, and Chester Griffiths, MD

More information:

Santa Monica: 310-582-7450 | Burbank: 818-847-6049 | PacificPituitary.org

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About the Author

Daniel F. Kelly, MD

Daniel F. Kelly

Daniel F. Kelly, MD, is the Director of the Pacific Brain Tumor and Pituitary Disorders Centers at Providence Saint John’s Health Center in Santa Monica, CA. Considered to be one of the top neurosurgeons in the U.S., Dr. Kelly is internationally recognized in the field of minimally invasive keyhole surgery for brain, pituitary and skull base tumors. He continues to focus his efforts on advancing innovative treatments for patients, providing fellowship training in minimally invasive neurosurgery, and patient education and support.

Last updated: June 5th, 2023