If a surgeon removes a tumor from inside your head, you might logically expect to feel better right away. However, if the tumor rests on the pituitary gland and the surgeon removes it in a minimally invasive procedure through the nose, you might not feel better for several weeks.

That is the conclusion of a recent study led by Lee Zimmer, MD, PhD, a skull base expert at the Brain Tumor Center at the University of Cincinnati Neuroscience Institute and Director of Rhinology and Anterior Skull Base Surgery at UC Health.

“The facts about quality of life in the short term after pituitary surgery are important for doctors and patients to know,” Dr. Zimmer says. “They need to have realistic expectations. Patients will not feel better right away after endoscopic pituitary surgery. In fact, for a short time they may actually feel worse than they did before surgery. They may experience increased sinus congestion and a compromised sense of smell.

“But within three months of their surgery, their symptoms are likely to have resolved,” Dr. Zimmer continues. “At three months patients are likely to feel better than they did before their surgery, and their quality of life is likely to have significantly improved. Patients can also expect to experience reduced feelings of sadness, frustration and fatigue while enjoying improvements in concentration and productivity.”

Dr. Zimmer’s research, the first to explore short-term quality of life after endoscopic pituitary surgery, was published in the Journal of Neurological Surgery. His co-authors included Jeffrey Keller, PhD, and former resident John DePowell, MD, from UC’s Department of Neurosurgery.

Skull base surgery, which involves the removal of lesions – typically pituitary or meningioma – from the lower part of the brain, traditionally was performed through an incision (craniotomy) in the skull. Today, about half of pituitary tumor surgeries are performed through the nose with endoscopes, long narrow tools that include a small camera and light. Surgery performed in this manner offers significant benefits to the patient, including shorter hospital stays and an absence of visible scarring.

A national leader in skull base research

Dr. Zimmer, who leads the UC Brain Tumor Center’s skull base team, is a national leader in skull base research. In addition to his recent study about quality of life following endoscopic pituitary surgery, he and his colleagues have contributed numerous articles to the evolving field of neuroanatomy, which shows surgeons which path through the skull base is safe and accessible and which landmarks cannot be crossed or touched. Surgeons must have a precise understanding of the complicated anatomy so as not to cause bleeding or harm to the patient.

Two recent articles, published in World Neurosurgery, explore the difficulty in approaching tumors from a tiny hole in the nose, below the tumor, rather than from a craniotomy above the tumor. Approaching from above, surgeons enjoy a three-dimensional view of the brain’s surface and interior. Approaching with an endoscope from below, through a far smaller opening, surgeons are restricted further by the endoscope’s two-dimensional presentation. While viewing around hidden corners with angled lenses, surgeons must picture in their mind’s eye the entire region where they are operating, the path they are traveling, and what nerves or arteries are connected to, or lurking behind, the lesion.

In the World Neurosurgery articles, Dr. Zimmer and his colleagues clarified and re-classified the endoscopic appearance of the internal carotid artery, a complex vessel characterized by multiple bends. Viewed in two dimensions, the artery’s segments can be difficult to distinguish from each other. The research performed by Dr. Zimmer and his colleagues will help fellow surgeons orient themselves safely when viewing the internal carotid artery in a two-dimensional endoscope.

It is one more way that clinician researchers at the UC Brain Tumor Center are providing – and improving – advanced specialty care at UC Health.

— Cindy Starr