Skull Base Surgery

Pituitary Tumors
Acoustic Neuromas

Pituitary Tumors

Pituitary tumors are endocrine tumors that form from the pituitary gland that resides in the base of the skull.  It can be secreting tumors that can lead to unusual problems such as growth hormone changes or they can be non secreting tumors that compromise the function of the pituitary gland and leads to lack of hormones where the patient may have changes relating to lactation, loss of sexual drive and loss of menstruation.  In addition, they can lead to visual problems as the tumor enlarges and presses on the nerves to the eye. 

It is fortunate that the tumors often protrude into the sphenoid sinus and, thus, what used to be a very complicated removal is now much more simple and safer for patients, without the need for a true brain operation.   In corroboration with the neurosurgeons, we remove these tumors through sinus endoscopic approaches.  This surgery takes place through the nasal cavity, through the sphenoid sinus and then through the back wall in which the neurosurgeons remove the tumor.  Patients are much more comfortable with this technique and have the ability to leave the hospital after several days.  Our experience has been vast, working as a team with the neurosurgeons for the past 30 years.  Results have been quite successful with minimal complications.

Acoustic Neuromas

Acoustic neuromas constitute 6 to 10% of all brain tumors. They are benign and usually are slow growing. Their early symptoms are deceptive because they are like those with many less serious problems.

The cells that form an acoustic neuroma are called schwann cells and make up the lining of the eighth cranial nerve as it passes through a tiny canal, which connects the inner ear to the brain. Unknown events lead to an overproduction of schwann cells. As they multiply, they form a small tumor which fills the canal.

As the tumor expands, it extends into the brain assuming a pear shape and putting pressure on the nerves and brain. By this time the patient may have had some of the symptoms that an acoustic tumor can cause - hearing impairment in one ear, ear noise called tinnitus, and fullness in the ear. Other symptoms which may develop include unsteadiness or imbalance and facial numbness or twitching. Continued growth can produce further symptoms, and death ay eventually result if the tumor goes undiagnosed and untreated.

The diagnosis of acoustic neuroma is made after a patient reports one-sided hearing loss, and the appropriate tests are done to locate the cause. Sophisticated audiometry testing can suggest that an acoustic neuroma is the cause of a hearing problem. CT and MRI scans are used to make the final diagnosis.

The good news for the person diagnosed with an acoustic tumor is that one is commonly cured the modern treatment. Surgery is the best treatment for most patients. The surgery is often done by a two-specialist team made up of a neurosurgeon (brain surgeon) and a neurotologist (ear surgeon).