procedure, like all planned operations, is methodical, calm,
controlled, predictable, with precautions in place for possible
problems or emergencies. The operation is so un-invasive,
it more resembles routine dental work than major surgery. Yet,
Laws and his colleagues are working at the very edge of the
brain. There is little room here for error.
past years, pituitary surgery was more dramatic, and intensive,
for both the surgeon and the patient. It involved removing
a portion of the skull and pushing the brain aside to reach
the pituitary. The recovery period was long, and there was
much greater risk for damage and complications. Laws and others
invented and refined the current technique — passage
through the nose — which rarely involves direct contact
with the brain, even as they operate within its midst.
pituitary gland is located at the base of the brain near the
spinal cord, in the lower center of the head. This gland, normally
the size of a pea, is the master gland that controls the production
of all hormones. The pituitary controls growth, sexual maturation,
fertility, metabolism, stress response and fluid balances.
reasons not well understood, the pituitary is subject to the
slow growth of tumors. These tumors are the third-most common
type of primary brain tumor, accounting for 20 percent of all
brain tumors. Though these tumors are almost always benign,
they aren’t friendly. They can cause the pituitary gland
to produce excessive or insufficient amounts of hormones, leading
to a vast array of
unpleasant symptoms, including severe and chronic headaches, infertility, sexual
dysfunction, fatigue, weight gain, depression, apathy, sleep disorders, memory
loss, and in some cases, loss of vision. Pituitary disorders also are the cause
of Cushing’s syndrome, which results in obesity, “moonlike” features
of the face, excess body hair and thin brittle bones.
by Andrew Shurtleff
| Pituitary surgeries are discussed prior to and after each operation.
the symptoms of pituitary disorders are so varied, it can take
years to arrive at a correct diagnosis,” Laws said. “Patients
often think that their health problems are attributed to just
takes a brain scan in the form of magnetic resonance imaging
to confirm the presence of a pituitary tumor. Sometimes the
tumor is three times the size of the gland itself, putting
pressure on the brain and optic nerve, resulting in headaches
and vision loss. Small tumors often can be treated with hormones
and drugs. Radiation may shrink the tumor or inhibit its growth.
If the tumor continues to grow, and symptoms worsen, surgery
may be necessary.
discovered early, at the beginning of his medical training
at Johns Hopkins University, that he was interested in neurosurgery.
His fascination with the brain has continued throughout his
40-year career as a surgeon and brain tumor researcher.
beautiful the brain is,” he said recently. “I’m
amazed with what happens with the human brain, and I love dealing
with it in an intimate fashion.” He describes the brain
as “one of the greatest of God’s creations.”
he’s happy to fix that creation when something goes wrong.
can restore vision,” he said of pituitary surgery. “We
can restore fertility and reverse body changes. This is enormously
tumors are identified using magnetic resonance imaging.
of the first patients Laws treated with the through-the-nose
surgical method was a 21-year-old man named Harvey Gartner.
The surgery was performed in 1969 at The Johns Hopkins Hospital
where Laws was a neurosurgery resident. Gartner had been growing
rapidly since he was 6 months old. His bones were elongated,
and he suffered from arthritis and other ailments.
were tough years,” Gartner said of his youth.
operation took 12 hours to complete, and all of the pituitary
gland was removed, as was standard at the time. Gartner, now
56, is on lifetime hormone replacement therapy, but his health
is generally good.
would have died,” if not for the surgery, he said.
is now a computer programmer and businessman in Jacksonville,
Fla. He has remained in contact with Laws, and the pediatrician
who cared for him throughout his life, Dr. Robert Blizzard,
a U.Va. professor emeritus of pediatric endocrinology. At the
time of Gartner’s surgery, Hopkins was the top pituitary
center in the United States. That title has long since shifted
to U.Va. as a result of Laws, Blizzard and others coming here
to establish their interdisciplinary center.
surgeons rarely need to remove the entire pituitary gland.
Instead, when surgery is necessary, they remove only the tumor
attached to the gland. The entire procedure, including prepping
the patient for surgery and the post-operative period, can
be accomplished in a couple of hours. The patient is able to
return home in two or three days and can resume normal activities
in two to four weeks.
a few days after surgery, the patient’s severe headaches
will have diminished. Vision will be restored within a day
in cases where the tumor had pressed against the optic nerve.
Body changes, such as weight loss and normalization of facial
features, will occur in about six months. Throughout the patient’s
life, teams of endocrinologists and other specialists will
measure the patient’s hormone levels and develop and
refine treatment plans. Laws said some patients might not even
need hormone replacement therapy.
don’t think anybody does this work better than we do
at U.Va.,” Laws said recently between surgeries. “We’re
improving our techniques and reducing the recurrence of tumors
At this moment he is called back into the operating room.
Another patient is prepped and waiting.
For treatment and research
interdisciplinary Pituitary Center at U.Va. pools the
talents of leading specialists in endocrinology, neurosurgery,
neuro-ophthalmology, neuropathology and other areas.
The specialists work as a team to diagnose patients and
develop treatment plans.
care professionals at the center evaluate about 500
new patients each year, most of them referrals from
around the Commonwealth, and the rest from other states
and around the world. More than 260 new patients are
operated on each year at the hospital and more than
a thousand patients per year are treated at the center’s
clinic at Fontaine Research Park.
18 months the center brings together patients and referring
physicians. The center provides training and education
for fellows, medical students and residents.
specialists are developing a national and international
referral base, providing pituitary information to physicians
and patients worldwide.
with the center are constantly looking for ways to
control and perhaps someday stop the development of
want to understand why these tumors develop in the
first place,” said Dr. Edward Laws, the center
trials are conducted at the center to evaluate the
effectiveness of new treatments, and Laws and other
surgeons are always refining surgical techniques and
developing new ones. They have operated on more than
350 patients with a “gamma knife” — a
precise beam of gamma radiation that can evaporate
abnormal pituitary tissue. This, and other techniques,
keep the center on the cutting edge.