Neurosurgery – Skull Base and Pituitary Tumors
Skull Base and Pituitary Tumor Care
Skull base tumors and tumors affecting the pituitary gland can cause a wide range of serious symptoms and can be life-threatening, whether or not they are cancerous. Treating them takes a multidisciplinary approach with neurosurgeons, otolaryngologists, radiation oncologists, ophthalmologists and other professionals working together to create a plan that effectively treats the tumor and preserves function and quality of life.
Even noncancerous tumors affecting the skull base or pituitary gland usually need to be removed, as they can keep growing. Cancerous tumors can also spread to other parts of your body.
You’re in excellent hands — the team at Penn State Health Milton S. Hershey Medical Center is skilled, experienced and committed to your health, safety and well-being. We’ll work with you to create a treatment plan specific to your tumor, health and other factors, and we’ll make sure you have all the support and services you need before, during and after treatment.
What is skull base surgery?
Skull base surgery, sometimes referred to as cranial base surgery, takes place at the bottom or base of the skull (cranial base) near the base of the brain cavity (also called the intracranial cavity). The anterior skull base separates the nose and sinuses from the brain and spinal fluid. The lateral skull base separates the ear, hearing and balance organs from the brain and spinal fluid. All along the skull base are critical structures, including blood vessels and cranial nerves that are essential to vision, facial movement, hearing, balance, swallowing and speech, among other functions. Skull base surgery is a highly specialized set of techniques to remove or repair lesions along this bony junction.
What is pituitary tumor (adenoma) surgery?
Pituitary tumor surgery is surgery to remove a tumor affecting the pituitary gland. The pituitary gland is located in the skull below the brain and above the nasal passages. It is considered the “master gland,” as it releases hormones that regulate various functions in the body and stimulates other glands to secrete hormones.
Most pituitary tumors are called adenomas and are noncancerous, but they can still cause significant health problems by causing the pituitary gland to produce too much or too little of certain hormones or by pressing on the optic nerve, which can lead to vision problems. A pituitary tumor can cause a wide range of symptoms, including headaches, infertility, erectile dysfunction and mood changes. To confirm the diagnosis, hormone testing of the blood and urine and magnetic resonance imaging (MRI) may be used.
The most common surgery for a pituitary tumor is called the transsphenoidal approach, done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. At the Penn State Health Milton S. Hershey Medical Center, it is most commonly done with an endoscope (a thin tube with a tiny camera) inserted through the nose. This way, no part of the brain is touched, and there is no visible scar.
For larger tumors, other surgical methods may be used. Our surgeons make every effort to minimize risk while fully removing the tumor and are highly experienced with all the surgical approaches.
Conditions we treat
Some of the conditions we treat include:
- Cancers of the nose or sinuses
- Cerebrospinal fluid leak (a tear or hole in the membranes surrounding the brain or spinal cord)
- Chordoma or chondrosarcoma (mass or cancer of the upper spine)
- Craniopharyngioma (rare type of noncancerous brain tumor)
- Encephalocele (a sac-like protrusion and projection of the brain and the membranes that cover it through an opening in the skull)
- Esthesioneuroblastoma or olfactory neuroblastoma (rare cancerous tumor that begins in the upper portion of the nasal cavity)
- Glomus tumor (affecting the temporal bone, which contains the middle and inner portions of the ear)
- Juvenile nasopharyngeal angiofibroma (rare noncancerous tumor in the nasal cavity, most common in adolescent males)
- Meningioma (a tumor in the meninges — the membranes that surround your brain and spinal cord)
- Optic nerve compression (a mass pressing on the optic nerve causing eye pressure)
- Orbital tumor (a tumor in the orbit, the socket in front of the skull that contains the eye)
- Pediatric skull base defects and tumors [link to condition conditions page when complete]
- Pituitary tumor or mass in the pituitary gland
- Rathke’s cleft cyst (fluid-filled mass within or above the pituitary gland)
- Schwannoma and neurofibroma (noncancerous tumors on the main nerve that connects the inner ear to the brain)
- Traumatic injury of the skull base
- Tumors of or around the eye
Depending on your initial symptoms, you will likely first see either a neurosurgeon, otolaryngologist (ear, nose and throat specialist or ENT), oculofacial plastic surgeon or ophthalmologist. A full and thorough discussion of your symptoms and physical examination will determine what tests are needed. Once a diagnosis is made, you will likely be scheduled to see other members of the team.
Testing may include:
- Computed tomography (CT or CAT scan) and magnetic resonance imaging (MRI) of the head and face
- Image-guided technology during surgery that allows us to assess the tumor and its location relative to important structures such as nerves and blood vessels
Our team includes neurosurgeons, otologists, head and neck surgeons, oculofacial plastic surgeons and ophthalmologists. The team holds regular tumor board meetings to discuss the care and treatment for complex cases. These meetings bring together the surgical team as well as our radiologists, pathologists and oncologists to offer a comprehensive treatment plan.
Depending on the location and type of your tumor and other factors, your plan may include:
- Minimally invasive surgery using an endoscope (a very thin tube with a camera attached) passed through your nose and sinuses or through a tiny incision to get to the tumor
- Radiosurgery using the Leksell Gamma Knife Icon delivering precise radiation therapy to treat tumors in the brain or elsewhere
- Open surgery when minimally invasive surgery is not an option
- Radiation or chemotherapy in addition to or instead of surgery
- Reconstructive surgery
Skull base and pituitary tumor surgery team
- Brad E. Zacharia, MD, MS
- Gregory D. Arnone, MD
- Ephraim W. Church, MD
- Seyed A. Mansouri, MD
- James McInerney, MD
- Elias B. Rizk, MD
- Michael D. Sather, MD
Otolaryngology – Head and Neck Surgery
Ophthalmology / Oculofacial Plastic Surgery
Our skull base surgery team is committed to improving skull base surgery and treatment for tumors in this delicate area. We’re active in research to make treatment as safe and effective as possible and to preserve functioning and quality of life. If we think you’ll benefit from participation in a clinical study, we’ll talk to you about whether it is right for you and what to expect.