Q. What are the latest advances in brain tumor and pituitary tumor surgery?
A. By Daniel Kelly M.D., neurosurgeon and Medical Director of the Brain Tumor Center at Saint John’s Health Center.
Neurosurgery is the surgical discipline focused on treating central, peripheral nervous system and spinal column diseases amenable to surgical intervention. At the Brain Tumor Center at Saint John’s Health Center, the primary focus is the treatment of brain tumors, skull base tumors and pituitary adenomas. The Brain Tumor Center provides comprehensive care for patients with all brain tumor types including primary brain tumors such as gliomas and meningiomas, pituitary adenomas which may cause acromegaly, Cushing’s disease and prolactinomas, as well as metastatic brain tumors that arise from cancers elsewhere in the body.
Typically patients are referred to the Brain Tumor Center by a neurologist, an oncologist, ophthalmologist, endocrinologist or a general practitioner. Tumors treated at the Brain Tumor Center are both benign and malignant. Common benign brain tumors include meningiomas, pituitary adenomas, schwannomas and craniopharyngiomas. Common malignant brain tumors include astrocytomas, gliomas, glioblastoma and metastatic brain tumors.
Today, because of refinements in micro-instrumentation, endoscopy (a surgical telescope that allows surgeons to look around corners with a panoramic view), and surgical navigation (“like GPS for the brain”), many brain tumors, skull base tumors and virtually all pituitary tumors are now removed through a small scalp incision or through a nostril. Commonly used approaches at the Brain Tumor Center are the supra-orbital “eyebrow” craniotomy (via an incision through the eyebrow), the endonasal approach (via a nostril without any skin incisions) and the retro-sigmoid approach (via an incision behind the ear). These minimally invasive approaches allow surgical access to many brain tumors that have traditionally been removed through larger scalp incisions and bony openings that require more muscle retraction and brain retraction. In general, these minimally invasive surgical approaches require less time for recovery and result in less post-operative pain than do traditional craniotomies.
Tumors may arise within the brain itself, over the surface of the brain, from the cranial nerves that exit the brain or in the skull base. The symptoms produced by brain tumors are highly dependent upon where the tumor is located and how rapidly it is growing. Typical brain tumor symptoms may include headache, loss of vision, double vision, weakness, incoordination, loss of sensation, personality changes and seizures. Pituitary adenomas which are benign growths of the pituitary gland may cause headaches, loss of vision or loss of pituitary hormonal function which can lead to fatigue, weight gain, impaired sexual function, low thyroid or growth stoppage in young people. In some pituitary adenomas, there may be excess hormonal production. In patients with Cushing’s disease, excess cortisol production may lead to weight gain, hypertension and diabetes. In patients with acromegaly, excess growth hormone production may lead to hypertension, diabetes, sleep apnea, enlarged hands and feet and carpal tunnel syndrome. In patients with prolactinoma, excess prolactin production may lead to weight gain, loss of libido, low testosterone in men, and loss of menstrual periods and milky breast discharge in women.
Although most patients with a brain tumor or pituitary tumor may need surgery, additional evaluations and treatments are often needed. For example, patients with malignant brain tumors such as gliomas or metastatic brain tumors will typically also need radiation treatment, radiosurgery and possibly chemotherapy. Patients with pituitary tumors will typically need to be evaluated and treated by an endocrinologist who specializes in hormonal disorders. At the Brain Tumor Center, our colleagues in Endocrinology, Oncology, Radiation-Oncology, Head & Neck Surgery, Neurology and Neuro-Ophthalmology, provide a comprehensive and multidisciplinary treatment approach. For additional information on the diagnosis and treatment of brain tumors, skull base tumors and pituitary adenomas, please go to our website: www.brain-tumor.org.
Daniel Kelly, M.D. is a neurosurgeon and the Medical Director of the Brain Tumor Center at the John Wayne Cancer Institute at Saint John’s Health Center. For more information about Dr. Kelly and other Saint John’s services please call (310) 829-8990 or visit the website at www.brain-tumor.org or www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.