At Miami Neuroscience Institute, we understand how complex pituitary tumor treatment can be. Our diverse team of specialists is highly skilled in diagnosing and treating pituitary tumors, including the most advanced surgical procedures. Every patient receives a personalized treatment plan designed specifically for their condition, symptoms and circumstances.
Pituitary tumor patients have access to the latest treatment technologies and medical therapies. Each patient receives a comprehensive evaluation from a team of specialists. This team is composed of several disciplines, including neurosurgeons, neuro-radiologists, neuro-endocrinologists, radiation oncologists and neuro-otologists (specialists in neurologic conditions of the ear, nose and throat).
This collaborative approach ensures that we can tailor your treatment to your specific tumor type, needs and preferences.
What type of pituitary tumors are treated at Miami Neuroscience Institute?
We treat both functional and nonfunctional pituitary tumors at Miami Neuroscience Institute, including:
- Nonfunctional adenomas
- Prolactin-producing tumors
- ACTH (adrenocorticotropic hormone)-producing tumors, which can cause Cushing’s disease
- Growth hormone-producing tumors, which can cause acromegaly
How are pituitary tumors diagnosed?
If your doctor refers you to us with a possible pituitary tumor diagnosis, we will first review your images.
We may request further testing, including imaging, such as a CT scan or an MRI, or bloodwork to determine the exact type of pituitary tumor. Humphrey visual field (HVF) testing and hypothalamic pituitary axis (HPA) blood work tests will be conducted to evaluate current visual status and status of the pituitary gland function. These tests will allow your team to develop a personalized and more effective treatment plan.
How are pituitary tumors treated at Miami Neuroscience Institute?
We find the best and safest treatment plan based on your tumor type and symptoms.
If you’ve been diagnosed with a pituitary tumor but aren’t experiencing symptoms, you may not require any immediate treatment. However, we will request that you schedule a follow-up in six months. At that time, you will have additional imaging and bloodwork to determine whether your tumor has grown and if you’ve developed symptoms.
If you are having symptoms, you may be treated with medication, surgery or both. Your entire team will meet to review all test results and recommend a treatment plan.
If surgery is needed, your surgical team has access to an intraoperative MRI, which allows specially trained neurophysiologists to track brain function during surgery. This monitoring gives neurosurgeons the ability to assess whether an entire tumor has been removed during the procedure. Miami Neuroscience Institute’s intraoperative monitoring program is certified by the American Board of Neurophysiology Monitoring (ABNM).
Our surgical team is very experienced in transsphenoidal and transcranial surgery, which may be performed on patients with pituitary tumors. Dr. Michael McDermott, neurosurgeon and chief medical executive, began his surgical career in 1990 and Dr. Vitaly Siomin, director of the skull base surgery program at Miami Neuroscience Institute, began his career 10 years ago. Together our neurosurgeons have combined of experience of 41 years.
After surgery, you will be brought to the intraoperative MRI scanner while remaining under general anesthesia. There, you will receive an MRI so the surgeons can confirm that they have removed as much of the tumor as possible. If they believe that more tumor can and should be removed, you will be taken back into the operating room for operative re-exploration.
After surgery, your doctor will have the tumor tested to determine if additional treatment is required, and you will receive additional visual fields (HVF) and HPA blood testing from your neurosurgeon and endocrinologist, respectively.
We may treat a pituitary tumor that returns with radiation therapy, including proton therapy. Thanks to our close collaboration with Miami Cancer Institute, you can receive your proton or other radiation therapy just a few minutes away from our Miami Neuroscience Institute offices.
When our team of physicians recommends radiation, our patients have access to every option available under one roof, including photon therapy and proton therapy. The first image displays the areas of the brain receiving radiation therapy with traditional photon therapy. Unlike photon radiotherapy, in which the brain outside the target still receives moderate radiation doses, proton therapy allows for more focused radiation to the region of the tumor or tumor bed. For patients with pituitary adenomas, this helps to spare the key areas of the brain responsible for neurocognition. The third image shows the clear difference in photon therapy and proton therapy. The areas in blue and turquoise are exposed to radiation with photon therapy, but spared with proton therapy.
Appel RH, Mehta MP, Tseng YD, Vargas C, Larson G, Hartsell W, Tsai H, Sinesi C, Laramore G, Rossi C, Rosen L, Badiyan S, Kotecha R. Proton Beam Radiotherapy for Patients with Pituitary Adenomas is Associated with Low Acute and Late Treatment-Related Toxicities. Oral presentation at 58th Annual Conference of the Particle Therapy Co-operative Group (PTCOG). Manchester, UK. June 10-15, 2019.
When you come to Miami Neuroscience Institute for pituitary tumor treatment, you can expect:
- A team dedicated to treating your pituitary tumor strategically and safely, without rushing into an unnecessary surgery.
- Seamless collaboration between neurosurgeons, ENT surgeons, neuro-radiologists, neuro-endocrinologists and radiation oncologists, all with the goal of providing more personalized and effective treatment.
- Endoscopic surgery that is less invasive and more effective than traditional pituitary tumor surgery.
- Intraoperative MRI imaging performed under general anesthesia to ensure that the surgeons have removed as much of the tumor as possible before the patient leaves the operating room.
What are the benefits of a pituitary team?
Our pituitary tumor team consists of about a dozen specialists. We meet once a month to discuss new patient cases and follow-up on existing cases. The entire team attends each meeting, and every specialist provides their treatment recommendation.
While our team members typically agree on which treatment will work best, there are times where a member may request additional testing. Once the team has met, the treating neurologist will share the team’s treatment recommendations or additional testing suggestions with the patient. This approach allows the patient to make an informed decision about what type of treatment they would like to receive.
Patients typically go home the day after surgery and return for a follow-up visit in six to eight weeks. If a patient requires radiology therapy, that will begin four to six after surgery is complete and the wound has fully healed.
The risks associated with pituitary surgery are very low. They include the standard risks associated with anesthesia or infection at the surgical site – the nasal cavity. About 6-8% of surgical patients will experience a cerebral spinal fluid leak, and about 3% will experience a carotid artery injury.