Prioritizing Patient Safety with Endoscopic Excellence

Updated from the article originally published June 17, 2020

Learn more about PNI’s pituitary team and their vision and strategy for putting patient safety first when it comes to endoscopic pituitary adenoma surgery.

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Primum non nocere … “First do no harm”

Whether this phrase comes from the Hippocratic Oath or subsequent medical scholars is debatable but it remains one of the guiding principles in medicine.

Understanding Pituitary Adenomas

At Pacific Neuroscience Institute and our Pacific Pituitary Disorders Center, this concept of “safety first” is paramount when it comes to removing pituitary adenomas, and related tumors such as craniopharyngiomas, Rathke’s cleft cysts, chordomas and some midline meningiomas—non-cancerous growths of the pituitary gland.

The great majority of symptomatic pituitary adenomas (the vast majority of which are benign and non-cancerous), require surgical removal as first-line treatment.

Common pituitary adenoma symptoms include:

• Loss of hormonal function (hypopituitarism)
• Excess hormone production
• Vision loss
• Headaches

The only subset of adenomas that can be reliably treated without surgery are prolactinomas, typically with a medication called cabergoline (a dopamine agonist).

The key goals of pituitary adenoma surgery are:

• Complete tumor removal
• Preservation or restoration of gland function
• Restoration of vision (if vision loss is a symptom)
• Avoidance of surgical complications

Accessing the Pituitary Gland with Endoscopic Techniques

Given where the pituitary gland is located, meeting this challenge is no small issue, it is located below the brain in the skull base, in an area called the sella turcica.

It is surrounded by critical structures, including the optic nerves and carotid arteries. Reaching pituitary adenomas safely requires extensive anatomical understanding and surgical experience in endonasal endoscopic and transsphenoidal surgery.

Careful planning of surgery is required to achieve optimal outcomes and to “do no harm” to our patients.

Safety First in Pituitary Adenoma Surgery

At PNI with over 2000 endoscopic endonasal surgeries performed for pituitary adenomas and related conditions, and more than 100 peer-reviewed publications, our focus on “Safety First” approach to pituitary surgery has resulted in consistent extremely low complication rates.

In our published experience of over 500 cases of endoscopic pituitary adenoma surgeries, the risks of major complications was <1% for vision worsening, stroke or other neurological decline, carotid or other blood vessel injury, blood clot, meningitis, deep vein thrombosis, pulmonary embolism, loss of sense of smell and death. A postoperative cerebrospinal fluid leak occurred in only 1.4% of cases.

In patients with preoperative vision loss, improvement was documented in almost 90% and in patients with preoperative headaches, improvement or resolution occurred in over 90%.

Tumor removal rates were also high, achieving total or near total removal in 90% of patients with endocrine-inactive adenomas. Notably of all these cases, over 20% had prior surgery performed at another institution.

A Team Approach to Minimally Invasive Pituitary Surgery

Performing safe and effective surgery for patients with pituitary tumors, tumors of the skull base and pituitary tumors requires collaboration among dedicated and experienced specialists.  At PNI, our team-based approach ensures optimal patient outcomes.

Over the last two decades, minimally invasive approaches to reach these often difficult-to-access tumors has flourished largely due to advances in neuro-anatomical understanding as well as refinements in instrumentation including the high-definition endoscope, ultrasound and surgical navigation.

How We Perform Surgery

In over 98% of cases, pituitary adenomas are removed via the nose (endonasal endoscopic route). This minimally invasive approach allows for direct access to the pituitary gland with minimal disruption to surrounding tissue.

At PNI our surgical philosophy is to maximize tumor removal while minimizing risk of collateral damage and complications through experience and use of the best available technology including high-definition, endoscopy, intraoperative navigation and the Doppler probe for blood vessel localization.

Recovery After Pituitary Adenoma Surgery

Most patients undergoing endonasal or keyhole craniotomy removal of a tumor impacting vision or eye movements are in the hospital for only one or two nights and are back to full activities within 3 weeks after surgery.

One-Stop Access to Pituitary Surgery Experts

Our comprehensive team approach allows patients with pituitary adenoma tumors to be evaluated by multiple specialists in our specialty PNI neuro clinics in Santa Monica, Torrance and Burbank. For example at PNI-Santa Monica, our patients can see experts in neuro-ophthalmology, neurosurgery, ENT, and endocrinology in one visit. Additional appointments may also be arranged for the same visit or on another day with our neuro-oncologists and our radiation oncologists.

>> Meet our pituitary disorders team

Additional Resources

As detailed in our publications, our PNI team has performed surgery on hundreds of patients with vision and/or eye movement deficits. These papers highlight the use of various keyhole approaches for such tumors including the endonasal and supraorbital route. Examples of these approaches are also in our keyhole surgery video library.

>> Pituitary disorders publications
>> Pituitary disorders videos

Contact Us

To learn more about our Pituitary Disorders Center and endoscopic endonasal surgery, or to get a second opinion about a pituitary tumor, schedule a consultation online or call 310-582-7450.