Better View of the Brain

Neurosurgery refines the removal of pituitary tumors

Endocrinologist Ariel Lev Barkan, M.D., (bottom left) works with adult neurosurgeons William F. Chandler, M.D. (top) and Stephen E. Sullivan, M.D. (right) at the Pituitary and Neuroendocrine Center.

Imagine you’re a patient diagnosed with a pituitary tumor. The pituitary gland, a pea-sized organ at the base of the brain, acts like a remote control that signals other glands to secrete hormones into the body. A wide range of symptoms may have led to your diagnosis – from infertility, obesity and depression to osteoporosis, growth problems or vision problems just to name a few.

And, though these tumors are rarely cancerous, your physician says you need surgery to remove it.

If you’re a patient at the University of Michigan Health System, standard microscopic surgery is not your only option. The Health System recently marked its 100th endoscopic endonasal surgery. Although more than 2,000 pituitary operations have been performed through the nose at the University of Michigan, the addition of endoscopic techniques has expanded the scope of this approach.

For the past 16 years, U-M physicians have run a multidisciplinary clinic for the treatment of pituitary tumors. Neurosurgeons William Chandler, M.D., and Steve Sullivan, M.D., perform brain surgeries every week, including removal of tumors of the brain, pituitary gland and skull base.

The endoscopic endonasal approach is multidisciplinary in that it requires the assistance of an expert skull base surgeon from the Department of Otolaryngology Head and Neck Surgery. Over the past five years, Sullivan has refined surgery on the brain and skull base using endoscopic techniques. Applying the endoscope to pituitary surgery provides an extended view (via the nose) of the skull base and pituitary so that larger tumors can be more safely removed.

“The endoscope has a wide and clear view of the entire skull including the jaw and even the further parts of the brain,” explains Sullivan. “We have even treated gunshot wounds and removed bullets this way.”

Benefits for patients include less time in the hospital post operation, no incision, no scarring and usually no pressure is applied to the brain.

“For many extensive cases, such as removal of large tumors or tumors which are in difficult to reach areas, the endoscopic technique adds benefits beyond the standard microscopic approach,” says Chandler.

“Not many people know about this still, and it really is much better than open brain surgery,” says Sullivan.

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