At Memorial Sloan Kettering, we offer expertise in a number of approaches for surgically removing pituitary and other skull base tumors. In addition to traditional craniotomy, a procedure in which surgeons remove these tumors through an incision in the skull, we offer a team uniquely skilled in minimally invasive endoscopy.
The Transnasal Endoscopic Approach
In this minimally invasive procedure, neurosurgeons Vivian Tabar and Marc Cohen insert an endoscope — a thin, lighted tube with a camera at its tip — through the nose to facilitate removal of pituitary tumors, meningiomas, clival chordomas, craniopharyngiomas, and other tumors located at the base of the skull.
Holding the endoscope and instruments through the nostrils, we open the sinuses for a magnified view of the skull base. With an endoscopic camera, we are able to visualize different angles as well as straight ahead, providing a more flexible and dynamic approach than the traditional microscope can offer.
Because the view is so clear, we are better able to remove all of a tumor while simultaneously preserving normal, healthy tissue. This high-definition approach is valuable when operating on small tumors hidden within the pituitary gland and when extracting relatively large tumors that extend into critical areas such as the optic nerves, cavernous sinus, and carotid artery.
The Nasoseptal Flap
In addition, we are experienced in performing endoscopic techniques that provide a safe, reliable way to separate the brain from the nasal cavity by using the patient’s own nasal septum tissue — known as a nasoseptal flap — that effectively prevents leakage of cerebrospinal fluid.
The introduction of this approach in recent years has transformed skull base surgery by providing a safe way to seal the nose from the brain after removing large tumors. The flap has its own blood supply, and our surgeons are experienced in implementing it using endoscopic techniques.
The risk for neurological complications with our endoscopic approach is very low, and the surgery leaves no visible scar. Recovery can begin right away, because there is little or no need for external incisions to heal. Patients are discharged from the hospital sooner than with traditional open surgery, often after just two or three days.
Intraoperative Magnetic Resonance Imaging (MRI)
At Memorial Sloan Kettering, our endoscopic surgeons are also able to use intraoperative magnetic resonance imaging (MRI) — one of just a handful of units in hospitals nationwide — to assist in the removal of tumors in complex areas such as the skull base with great precision.
This enhanced accuracy not only helps in preserving non-tumorous tissue and preventing post-operative complications but also reduces the likelihood that a second surgery will be needed.