Most tumors of the pituitary are benign. They all need a team approach and thus we collaborate with ophthalmology, neurosurgery, endocrinology and radiation oncology. Many of these may be managed with medical therapy alone. Small tumors may often be observed. However, if they grow or fail to respond to medical therapy or observation then surgery is often indicated. Patients often present with headaches, pressure and visual changes especially loss of peripheral vision. Surgery is usually done through the nose in a minimally invasive endoscopic manner.
The key in surgery is the reconstruction of the skull base to prevent postoperative infections or CSF leaks after surgery. Using the septum and or grafts (fascia lata or fat graft) is invaluable in this regard. For any remaining disease that can’t be removed with surgery, radiosurgery (Novalis, Cyberknife, Proton Beam therapy) is often needed. Occasionally, an approach from above (traditional transcranial approach) is needed if minimally invasive techniques are not successful. Dr. Ducic was the first surgeon in North Dallas to utilize endoscopic pituitary techniques that are now the standard of care.