Feb. 12, 1999 By Victoria White
GAINESVILLE, Fla.---Pauline David had steeled herself for a second devastating surgery. Her pituitary tumor had regrown, and she knew from experience what lay ahead: days in the hospital, severe pain and a face so bruised it would look like she had been beaten with a bat.
But University of Florida neurosurgeon Albert L. Rhoton Jr., had a surprise for her: Since her first surgery six years earlier, he had developed a new approach that shaved hours off the operating time and reduced the pain to just a fraction of what it had been before.
“I was sitting up in bed, chatting and laughing the first night after surgery. The next day, you would never have known I had had an operation,” David said of the procedure she underwent last April at Shands at UF. “I remember waking up after the first operation and being in so much pain. The second time, I thought, ‘This is it?’ I was almost joyful. It felt so good, I almost couldn’t believe it.”
The pituitary gland lies at the base of the brain just behind the nose. Pituitary tumors tend to be slow-growing and benign, but can result in the release of too much or too little of a variety of hormones that control growth, metabolism and reproduction. Tumors also can press on the optic nerve, interfering with vision.
Surgery to remove pituitary tumors traditionally has required an incision at the top of the upper gum or in the front part of the nose. Surgeons then proceed through the sphenoid bone and the sphenoid sinus just below the pituitary gland. That route accounted for much of the postoperative pain and swelling. But through his studies of anatomy and use of a surgical microscope, Rhoton discovered a more direct approach to the pituitary. For the past two years, he has been attacking tumors by going straight through a nostril and making a small hole at the back of the nose.
Rhoton, who has treated more than a thousand patients with pituitary tumors, has taught his technique at national conferences. At one such conference, he met a surgeon from Israel who independently had developed the same approach.
“Before, it often took 90 minutes from the beginning of the operation to expose the tumor. Now, with the endonasal approach, it usually takes about 15 minutes,” said Rhoton, a professor in the UF College of Medicine’s department of neurosurgery and a researcher affiliated with UF’s Brain Institute. “Before, it would take up to an hour to close up the lip or nasal septum and pack the nose to control the bleeding. Now, once you’ve removed the tumor and closed the area around it, you’re done. You don’t have that hour working on the nose.”
Hospital stays have been reduced to two or three days, compared to five or six days with surgery through the upper gum and three or four days for surgery through the nasal septum.
“Dr. Rhoton’s technique is a dramatic improvement in the speed, safety and efficacy of pituitary surgery,” said Dr. William A. Friedman, who recently succeeded Rhoton as chair of UF’s department of neurosurgery. “I have found his approach to be tremendously helpful in my own practice.”
For many weeks after her first operation, David was dizzy, couldn’t drive and suffered severe headaches. “But the second time it was amazing,” said David, who lives in Winter Park, Fla., with her husband and four children. “I was able to go back home and care for my newborn baby without any problem. It was like night and day compared to the first surgery.”
UF department of neurosurgery: http://www.neurosurgery.ufl.edu
University of Florida Brain Institute: http://www.ufbi.ufl.edu
Shands at UF: http://www.shands.org
Pituitary Tumor Network Association: http://www.pituitary.com
Recent UF Health Science Center news stories: http://www.health.ufl.edu/hscc/index.html
The UF Health Science Center topic/expert list: http://www.health.ufl.edu/hscc/experts.html
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