Recently, a patient with acromegaly — a condition that often results from a hormone-secreting tumor in the pituitary gland — arrived at UCSF's California Center for Pituitary Disorders. She had undergone what appeared to be a successful surgical resection of her tumor, but the condition persisted and she was hoping to avoid the radiation therapy her physicians recommended.
By comparing and MRI the patient had undergone before her surgery to one she underwent at UCSF, and interdisciplinary UCSF team discovered a previously unidentified tail of the original tumor. Neurosurgeon Sandeep Kunwar, MD, removed the remaining tumor using a minimally invasive endonasal transsphenoidal approach. There was no incision, minimal blood loss and no need for nasal packing. By the next morning, the patient's hormone levels had returned to normal.
"The case demonstrates the advantages of the interdisciplinary experience," says Kunwar, who has been removing tumors using the minimally invasive endonasal approach for 20 years.
Teamwork and Experience Yield Best Results
The California Center for Pituitary Disorders completes approximately 250 endonasal transsphenoidal cases per year using both endoscopic and microscopic approaches, making it among the busiest centers in the counters country. Its cure rates are above 90 percent, and complication rates are one-seventh of the national average for pituitary surgery.
"And a lot of pituitary lesions don't need surgery at all, so experience reading the scans and pattern recognition are enormously important," says Kunwar, noting that the center's team includes pituitary radiologists, neuroendocrinologists, pathologists and pituitary surgeons, as well as headache specialists and ophthalmologists.
"Our team's comprehensive perspective is important because not everything that looks like a tumor is a tumor," says neurosurgeon Manish Aghi, MD, PhD. "We make sure patients understand all of their treatment options."
The Right Procedure for Each Patient
When surgery is necessary, both minimally invasive approaches — microscopic and endoscopic — have their advantages, especially in the hands of a skilled surgeon.
The microscope allows the surgeon to view the tumors and surrounding areas in 3-D, making it easier to remove the pseudocapsule associated with hormonally active tumors. The endoscope, says Aghi, provides "spectacular illumination and the ability to see wider areas and look around corners, which can be especially helpful for larger tumors, such as those that are four to five centimeters in diameter."
Both surgeons argue that early referral is the best way to leverage the advantages of the UCSF center, especially when surgery is required. "Headaches or vision loss can be devastating, and the best chance for a cure is the first operation," says Kunwar. "The earlier you catch these patients, the more of a chance you have to impact quality of life."
This article was written by Andrew Schwartz and first appeared in UCSF Neuroscience News