Revolutionary endoscopic approach enhances a surgeon’s ability to reach critical areas of brain and spine

Sheri Yancey’s migraine headaches were getting worse—more frequent and severe, along with strange, frightening dizzy spells.

The 48-year-old Cedar Rapids, Iowa, woman had attributed these migraines to stress, but as the symptoms intensified, she got worried.

“They began coming on more suddenly. The pain would radiate from the back of my head to the front or from one side to the other.”

Her family physician referred her to Mark Fortson, M.D., a Cedar Rapids neurologist, who performed an MRI scan and spotted the culprit: a pituitary adenoma. Pituitary adenomas—usually benign, slow-growing tumors—can create multiple problems (including headaches, abnormal hormone secretion, loss of peripheral vision, and in some cases even blindness), particularly if they invade structures on either side of the pituitary gland.

Fortson referred Yancey to the UI neurosciences team at University of Iowa Hospitals and Clinics, where she was initially seen by Matthew Howard, M.D., professor and head of neurosurgery; and Scott Graham, M.D., professor of otolaryngology—head and neck surgery.

Howard mentioned that, instead of the “traditional” surgery for pituitary tumor removal, Yancey should consider seeing Jeremy Greenlee, M.D., assistant professor of neurosurgery, who has specialized expertise in performing a relatively new procedure called endoscopic transnasal brain surgery. UI Hospitals and Clinics is one of the first hospitals in the Midwest to offer the innovative procedure, which greatly enhances the surgeon’s ability to access tumors in hard-to-reach areas of the brain, and even the spine.

“I agreed right away,” Yancey says. “I had been doing lots of research on procedures available for tumor removal, and this seemed best—less invasive.”

The longstanding surgery for removing pituitary tumors is called transphenoidal hypophysectomy. This technique requires an incision under the upper lip or the front part of the nasal septum and the use of small surgical chisels, drills, or other bone-dissecting instruments to access the pituitary gland.

In sharp contrast, endoscopic transnasal brain surgery involves the use of a thin fiber optic tube (endoscope) that allows the surgeon to see well without making a large incision. The surgeon passes instruments through normal nasal passages and opens a small hole in the sphenoid sinus to reach the pituitary gland and remove the tumor.

This less invasive approach translates to less discomfort and recovery time. Currently at UI Hospitals and Clinics, it’s a five-day hospital stay for traditional surgery versus three or four days for endoscopy. The endoscopic procedure has been found to be equally effective at tumor removal and there are no added risks or visible scarring.

Greenlee learned the technique from a world-renowned minimally invasive surgery specialist in Sydney, Australia. He and Graham performed surgery for Yancey in mid-October.

“It was amazing how much better I felt,” Yancey says. “I was up and around the following day, and I went home after three days. I’ve had only a few mild, more normal headaches since. I most definitely would recommend this procedure to anyone who needed it.”

Greenlee says that Yancey’s prognosis is very good. “Post-operative scans found no tumor remaining,” he says. “She will have periodic scans to check that she doesn’t have any recurrence, but the majority of patients do not.”

 For more information, patients may call UI Health Access at 800-777-8442, and for consultation and referral, physicians should call UI Consult at 800-322-8442.

Pituitary: a pea-sized gland located at the base of the brain (just above the back of the nose and under the eye glands). It is called the “master gland” because it releases eight different types of hormones that influence nearly every part of the body.

UI Hospitals and Clinics is one of the first hospitals in the Midwest to offer the innovative technique, which is more comfortable for patients and requires less time in the hospital.

Lighting the Way
Jeremy Greenlee, M.D., demonstrates an endoscope that is passed through the patient's nasal passages to more easily reach tumors located near the brain and spinal cord.