Harvey Cushing may be best remembered for his successes in the operating room, but as any student of the legendary neurosurgeon will tell you, the study of the pituitary, the stowaway gland whose function remained stubbornly elusive to the physicians and surgeons of the early 20th century, was his first and greatest true love.
Cushing, who came to Hopkins in 1897 to train under William Halsted, published a seminal monograph on the pituitary 1912, the year he left for Harvard. He then pioneered the trans-sphenoidal approach to the pituitary. Though Cushing himself later abandoned the approach, this surgical corridor to the skull base eventually became the first-line method for removal for pituitary adenomas, and it remains so today.
Now Henry Brem, the Harvey Cushing Professor and director of neurosurgery, is continuing the work his namesake began more than a century ago here at Johns Hopkins. Along with two endocrinologists, Brem recently established the Pituitary Tumor Center, a comprehensive program managed by a team of endocrinologists, neuro-ophthalmologists, neuro-radiologists and surgeons.
The surgical team, fully versed in the intricacies of operating on the pituitary gland, has further refined the transsphenoidal removal of pituitary adenomas with techniques that make the procedure safer and more effective. Intraoperative MRI makes it possible to guide and document the amount of tumor removal during surgery. A direct endonasal approach, versus the conventional sublabial approach, allows the mass to be removed via an incision in the lining of the nose. Encoscopic surgery is used an adjunct for resection.
When tumors extend beyond the limits of the transsphenoidal operation, a more extensive operation requiring a craniotomy may be needed. But, says Brem, “we always try the least aggressive method first.”
The Pituitary Tumor Center can schedule patients for multiple consults and tests during one visit. Info: 410-955-4526 or www.hopkinsmedicine.org/pituitary_center