A Tiny Tumor; One Huge Problem
Few people know their body as well as Betty Doyling, a personal trainer from Warwick, Bermuda. That said, a pituitary tumor was the last thing on Betty’s mind. A collaboration between George A. Scangas, MD, a sinus and skull base surgeon at Mass Eye and Ear, and the Neuroendocrine and Pituitary Tumor Clinical Center at Massachusetts General Hospital, would prevent the tumor from ruining her eyesight.
It kept growing, growing, growing…
According to Dr. Scangas, approximately one of every 10,000 people develops a pituitary tumor in their lifetime, making it one of the most common types of brain tumors. The pituitary gland, which is pea-sized, sits in a tight space along the skull base, right behind the nasal sinuses and between the eyes. While tiny, the gland is responsible for regulating vital hormones for growth, blood pressure and reproduction.
Most often, pituitary tumors are benign. However, they become dangerous if they grow too large and press against the optic nerve, jeopardizing a person’s vision. Upon discovering Betty’s tumor, doctors in Bermuda first attempted to shrink the tumor using medication. Eight weeks later, the tumor had not shrunk and was beginning to press against the nerve.
As a personal trainer, Betty couldn’t afford to lose her vision and her ability to focus on her clients. She also knew how debilitating poor eyesight can be from her mother, who was legally blind.
Doctors would need to extract the tumor from the middle of Betty’s head to keep her eyesight out of harm’s way. There was just one problem: Not a single doctor in Bermuda could perform the sophisticated endoscopic procedure needed for the extraction. Thankfully, her endocrinologist, Andrew Jamieson, MRCP, PhD, knew the best place to go.
“He told me that if he had this particular tumor, Mass Eye and Ear and Massachusetts General Hospital would be the only place he’d go to get treated,” Betty said. “Before I knew it, I had my flight booked and I had a date scheduled for surgery.
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Pulling a tumor out through the nose
Surgeons have little margin for error when extracting a pituitary tumor. The pituitary gland sits too close to critical structures – such as the optic nerve, major arteries and the brain – for doctors to slip by even a millimeter. One wrong move could result in impaired vision, damage to the skull base or, in extremely rare cases, uncontrolled bleeding and stroke.
So, how does a surgeon safely pull a pituitary tumor out from someone’s head? By going through the nose. In a minimally invasive procedure called a transsphenoidal anterior skull base surgery, a rhinologist uses an endoscope to open the sinus so that a neurosurgeon can extract the tumor from the skull base. After extraction, the rhinologist repairs the skull base, which keeps the brain separated from the nasal and sinus passages.
At the Mass General Neuroendocrine and Pituitary Tumor Clinical Center, Dr. Scangas and neurosurgeon Brooke Swearingen, MD perform these complex procedures on a regular basis to ensure optimal outcomes. The center provides an integrated approach to patients with pituitary and hypothalamic disorders, bringing together the expertise of more than 20 physicians specializing in neurosurgery, endocrinology, neurology and radiology at Mass General, and rhinology at Mass Eye and Ear. The expertise and familiarity between each doctor at the center are what make these complicated procedures fairly routine.
“The more you work with a specific co-surgeon, the more streamlined the process becomes, especially with a procedure as complex as anterior skull base surgery,” Dr. Scangas said. “The MGH neurosurgeons and Mass Eye and Ear rhinologists have an incredible relationship. Our experience and teamwork make a huge difference in the care of our patients and is such a strength of the Mass General Brigham system.”
