A highly skilled neurosurgical team is directed by Sandeep Kunwar, MD, specializing in transsphenoidal surgery for pituitary adenomas and parasellar lesions. The objective of the surgical team is always to optimize cure and preserve gland function.
Transsphenoidal Surgery for Pituitary Tumors
In 2000, the direct endonasal approach for transsphenoidal surgery was developed at UCSF making this surgery even less invasive and greatly reducing surgical complications. More of these operations have been performed at UCSF than any other site in the United States. With transsphenoidal surgery, surgeons approach the pituitary gland through the nose and sphenoid sinus — transsphenoidal means "through the sphenoid sinus." Using a microscope or an endoscope, they can navigate through these passages and remove the tumor through the nose without needing to make an incision in face or drill through the skull.
Advantages to the endonasal transsphenoidal operation:
- No intranasal or sublabial incisions
- No nasal packing
- Improved visualization and illumination with the use of an endoscope
- 85% of patients return home the day after surgery, regardless of tumor size
- Complete removal of tumors as large as 5 cm
- Tumor is removed with preservation of the normal gland
- Minimal blood loss
- Low complication rates (0% mortality in over 1000 operations, <1% major morbidity)
- Large experience minimizes risk of recurrence or need for postoperative radiotherapy
Extended Transsphenoidal Surgery
Extended transsphenoidal surgery extends into the brain cavity without requiring a craniotomy and is used to treat tumors that can not be reached by the standard method, including meningiomas, chordomas, and chondrosarcomas, as well as clival tumors, craniopharyngiomas, and tumors of the hypothalamus or optic nerves.
Endoscopic Endonasal Surgery
With the endoscopic endonasal approach, surgeons use an endoscope - a wand with a camera attached to the tip - to see further into the sinonasal and parasellar sinuses than they are able to with a standard microsurgical approach. This approach still goes through the nasal passages and is minimally invasive. It is especially useful for more invasive lesions that are suspected of spreading to other areas of the sinuses. Usually a neurosurgeon and an otolaryngologist will perform this surgery together. Otolaryngologists have a special knowledge of the anatomy of the nasal passages that help them to guide the endoscope towards the pituitary region. Once there, neurosurgeons can remove any lesion from the brain. Having two surgeons working together gives patients the benefit of more expertise, and it can also shorten operating time. Endoscopic endonasal surgery can also be used as a minimally invasive way to remove other tumors of the skull base such as meningiomas, chordomas, chondrosarcomas, craniopharyngiomas, and tumors of the hypothalamus or optic nerves.
Craniotomy for pituitary adenomas is very rare, but minimally invasive keyhole craniotomy is a treatment option, if necessary. Even large pituitary adenomas can now be approached by the extended transsphenoidal approach.