March 2, 2021 by John Fernandez
Pituitary Tumors & Vision Issues: Grateful Patient Sees Full Recovery After Surgery at Miami Neuroscience Institute
Carol Bailey does not hesitate to let someone know that she enjoys “life tremendously.” She loves to take motorcycle trips with her husband. They go airboating and camping, thoroughly reveling in the outdoors. But not too long ago, her life took an unexpected and frightening turn after experiencing bouts of vertigo and some vision problems.
Ms. Bailey (pictured above with her husband Paul Bailey while on a cruise off Alaska) was diagnosed with a pituitary tumor that was causing issues with her vision. More commonly known in the medical field as pituitary adenomas, these growths are benign and don’t spread outside the skull. They usually stay in the tiny space in the skull where the pituitary gland sits. The pea-sized pituitary gland helps control hormones that regulate growth, metabolism, stress response and sexual function.
“When I first found out it was a tumor, I was a little scared — to say the least,” says Ms. Bailey. “It was more about the unknown of what was going to happen and what it could be and what could happen to me.”
(Watch video: Hear from patient Carol Bailey as she recounts her diagnosis of a pituitary tumor and her surgery. Also hear from her medical team: Michael McDermott, M.D., neurosurgeon and the chief medical executive of Miami Neuroscience Institute; and neurosurgeon Vitaly Siomin, M.D. Video by Alcyene de Almeida Rodrigues.)
Most pituitary adenomas don’t cause symptoms. As a result, many are not diagnosed. The rate of incidence is about 1 per 100,000 population, said Michael McDermott, M.D., neurosurgeon and the chief medical executive of Miami Neuroscience Institute.
How Pituitary Tumors Affect Vision
However, pituitary adenomas can slowly grow into the boney walls and nearby tissues, such as blood vessels, nerves, and sinuses. They don’t grow very large, but they can have a big impact on a person’s health, including vision. And sometimes, but not commonly, require surgical removal. Pituitary adenomas are the fourth most common intracranial tumor after gliomas, meningiomas and schwannomas. A large majority of pituitary adenomas are benign and are relatively slow growing
“Pituitary adenomas are one of the most common benign brain tumors they occur in the skull base where the pituitary gland sits and they can either be functional, meaning they secrete a hormone, or non-functional,” explains Dr. McDermott. “With the non-functional tumors that present with visual disturbances, we want to protect the optic apparatus from chronic compression and irreversible nerve fiber loss to preserve the patient’s vision.”
Employed at Baptist Health South Florida for 20 years, Ms. Bailey would undergo the removal of the pituitary adenoma by a team of distinguished surgeons and specialists at Miami Neuroscience Institute, which has helped advance or pioneer treatment of brain tumors. The team included lead neurosurgeon Vitaly Siomin, M.D., Dr. McDermott, and Francisco Pernas, M.D., an ENT or otolaryngologist, affiliated with Baptist Hospital and other Baptist Health facilities.
“Both Drs. Siomin and McDermott were both were very clear with me that it was benign and not to worry,” recalls Ms. Bailey, who is executive assistant to Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute . “They were both excellent in treating me and assuring me that everything would be okay.”
Upon Ms. Bailey’s diagnosis, Dr. Siomin said they decided to monitor Ms. Bailey’s pituitary adenoma for a few months. Because the optic nerve is so close to the pituitary gland, it is often affected by pituitary tumors, leading to vision problems.
Dr. Siomin said Ms. Bailey first presented with symptoms that are not necessarily associated with pituitary adenomas, including episodes of vertigo and “on and off visual changes.” There was compression of the optic nerve, which is not unusual in these cases. “But the compression did not appear critical, so we decided to follow up and repeat the MRI of the brain at some point later.”
About six months later, the visual issues worsened, and Dr. Siomin’s team decided it was time remove Ms. Bailey’s pituitary adenoma. She started to have some more visual symptoms and develop what’s called scotomas, or spots of blurriness or distortion in different parts of the visual field, says Dr. Siomin.
“The tumor did not grow over the six months but it was quite large to begin with,” explains Dr. Siomin. “She did have compression on the optic nerves and that was the immediate cause of her visual problems. We decided to take her to the operating room to decompress the optic nerves and remove as much of the tumor as safely possible and the diagnosis was quite clear: it was a pituitary adenoma.”
Performing transsphenoidal surgery is the most common way to remove pituitary tumors. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. The back wall of the sinus covers the pituitary gland.
An endoscope, a thin fiber-optic tube with a tiny camera at the tip, is used. The surgeon passes instruments through the nose and opens the sphenoid sinus to reach the pituitary gland and take out the tumor. Whether this technique can be used depends on the tumor’s position and the shape of the sphenoid sinus.
“We perform these procedures with ENT (Ear, Nose and Throat) colleagues (Dr. Pernas in Ms. Bailey’s case) and it is a very good illustration of a team approach,” says Dr. Siomin.
Using ‘Intraoperative MRI’
After the two-hour surgery, and while the neurosurgeons and the patient were in the operating room, the team used state-of-art technology known as intraoperative magnetic resonance imaging, or just IntraOp MRI, to determine whether they had removed the entire tumor. If they see remaining tumor residue, they can continue the procedure until they have removed as much of it as possible, in the safest manner. In the case of Ms. Bailey, the IntraOp MRI revealed that the tumor was fully removed.
“The MRI machine comes into the operating room over the patient and we can perform the scanning right there on the spot without actually interrupting the flow of surgery,” explains Dr. Siomin.
Drs. Siomin and McDermott emphasized that Ms. Bailey’s case is a good example of a successful surgery with a fairly quick recovery. “The vision comes back and patients they feel they can see much better,” explains Dr. Siomin. “The dark spots are gone and the visual fields widen — but that doesn’t happen in every case. And recover may take some time.”
But Ms. Bailey started seeing improvements in her vision in a matter of days.
“Carol’s case was an example of the best-case scenario, and that is complete removal with no intraoperative cerebral spinal fluid leak,” said Dr. McDermott. “Her recovery was very straightforward and she went home on the second day postoperatively.”
She is now close to resuming her fully active lifestyle.
“It’s been just over three months and I feel fine,” says Ms. Bailey. “And I don’t have any side effects and no problems with vision other than my normal vision. I can’t wait to start having my life back and going on outings and do the things we enjoy like going out on the motorcycle. Everything’s great.”
Dr. McDermott says Ms. Bailey’s case illustrates the need to expand treatments of pituitary disorders, which are becoming more common.
“Pituitary tumors require a dedicated group of individuals to care for the patients properly,” says Dr. McDermott. “At Miami Neuroscience Institute, we plan to develop a center for pituitary disorders, along with our colleagues in head and neck surgery, ENT (ear, nose and throat), radiation oncology, and neuroendocrinology. We have the technical expertise on the surgical side. We have the equipment necessary to do the intraoperative imaging that confirms the extent of resection. And then we have the individuals who are capable of providing follow-up adjuvant treatment, if necessary.”