Intense focus on avoiding complications in a very delicate brain procedure has shown remarkable success among 514 patients treated over the past decade at Providence Saint John’s Health Center. An advanced minimally invasive surgical approach through the nostrils was used to remove pituitary adenomas, a type of tumor.

More than 98 percent of patients in this landmark study at the hospital’s Pacific Neuroscience Institute were discharged to home after tumor removal, spending an average of just two days in the hospital. Hospital stays decreased over time with many patients going home one day post-surgery. Less than 1 percent of all patients sustained any permanent neurological injuries.

The findings were published in this month’s journal “Pituitary” and highlight the importance of protocols to avoid complications in patients undergoing endoscopic endonasal surgery for pituitary adenomas. Developed in large part at PNI and several other pituitary centers of excellence, these protocols set new standards for achieving the best possible outcomes for pituitary adenoma surgery.

Over the 10-year study, the surgical team focused on consistent measures to avoid complications such as loss of sense of smell, nasal bleeding, carotid artery injury, pituitary gland damage, cerebrospinal fluid leaks and meningitis.

“Surgeons should continually strive to improve their results for their patients,” said neurosurgeon Daniel Kelly, M.D., director of PNI and senior author of the study. “Endoscopic pituitary surgery, which really started just over 25 years ago, is technically demanding and anatomically challenging given the location of the vital pituitary gland nestled in the skull base, surrounded by critical structures such as the optic nerves and carotid arteries. The operative corridor through the nostrils also contains the olfactory nerves for our sense of smell.”

Pituitary adenomas make up approximately 15 percent of primary brain tumors requiring surgery and almost always are benign. They can cause pituitary gland failure, vision loss, headaches and in some cases, over-secretion of hormones leading to conditions such as acromegaly (excess growth hormone) and Cushing’s disease (excessive cortisol.)

“Our surgical goal is always to ‘sneak in and sneak out’, removing the tumor as completely as possible while leaving all these vital structures intact,” Dr. Kelly said.

More than 90 percent of patients with preoperative vision loss, partially or completely regained their vision with no cases of permanent vision decline after surgery. There were no carotid artery injuries and no complete loss of sense of smell. The most common surgical complication was a post-operative cerebrospinal fluid leak occurring in 1.7 percent of patients, which fell to 1.2 percent in the second half of the study. Worsening pituitary gland function occurred in 4.7 percent, while more than 50 percent saw gland function improve.

The results, Dr. Kelly said, suggest that collaborative team surgery with neurosurgeons and ear, nose and throat surgeons applying consistent safety protocols, hugely benefits patients, and compared to prior large series, these results are among the best and most extensive published.

“We believe these results set a new standard for complication avoidance and optimizing outcomes for pituitary adenoma surgery and are happy to share this experience with colleagues who manage these patients,” he said.

Submitted by Patricia Aidem, Providence St. John’s Health Center