The Pacific Brain Tumor Center [BTC] & Pituitary Disorders
Program provides comprehensive care for patients with brain, skull base and
pituitary tumors, including both benign and malignant brain tumors, skull base
tumors, pituitary adenomas as well as related problems such as pituitary
hormonal failure (hypopituitarism), cerebrospinal fluid leaks (CSF leaks),
intraventricular tumors, spinal cord tumors and hydrocephalus. We also treat
cranial nerve syndomes including trigeminal neuralgia, hemifacial spasm and
Our Specialists in Neurosurgery, Head & Neck Surgery (ENT), Endocrinology,
Medical and Neuro-Oncology, Radiation-Oncology, Neuro-Ophthalmology,
Interventional Neuroradiology and Neuropathology offer a multidisciplinary
approach to these disorders. With expertise in minimally invasive keyhole and
endonasal endoscopic surgery, stereotactic radiation treatment, cutting-edge
cancer treatments, genomic sequencing and hormone replacement therapy, we
provide individualized care for these complex problems.
Through collaboration with the John Wayne Cancer Institute and Saint John’s
Health Center, the BTC also conducts Translational Research, Clinical Trials,
Continuing Medical Education, Neurosurgical Fellowship Training and provides
Patient Education and Support.
Specific disorders we treat include primary brain & skull base tumors:
pituitary adenomas (including acromegaly, Cushing’s disease, endocrine-inactive
adenoma, prolactinoma, recurrent and residual adenoma, pituitary apoplexy)
clival chordoma, chondrosarcoma, colloid cyst, craniopharyngioma, epidermoid
cyst, glioma (including low grade astrocytoma, choroid plexus papilloma,
oligodendroglioma, anaplastic astrocytoma and glioblastoma multiforme),
hemangioblastomas, CNS lymphoma, meningioma (including typical, atypical and
anaplastic), olfactory neuroblastoma (esthesioneuroblastoma), sinonasal
carcinoma, Rathke’s cleft cyst.
We also treat many patients with metastatic brain tumors including those
arising from breast cancer, colon cancer, lung cancer, ovarian cancer, renal
cancer, thyroid cancer and from metastatic melanoma.
Surgery for brain tumors, skull base tumors and pituitary adenomas is a
highly specialized area of neurosurgery that continues to rapidly evolve. At the
BTC, we incorporate cutting edge technology and instrumentation with proven
surgical experience to make surgery safer, less invasive and more effective.
These advanced technologies include MRI fiber tractography, functional MRI,
surgical navigation (GPS), evoked potential monitoring, awake craniotomy protocols, ultrasound for tumor
localization and the Doppler probe for blood vessel localization.
Given these major advances over the last decade, most brain and skull base
tumors can now be removed via a keyhole approach through a small craniotomy
(bony opening in the skull) or the nostrils. The ideal approach is determined by
the specific tumor anatomy in each patient. These include the endonasal
endoscopic (through the nostrils), supra-orbital (through the eyebrow),
retromastoid (behind the ear), mini-pterional route (in front of the ear) and
other keyhole and conventional craniotomies. Regardless of the route chosen, our
goals are to maximize tumor removal and minimize manipulation of critical
structures, thereby avoiding complications and patient disfigurement, while
promoting a more rapid, complete and less painful recovery. Notably, endoscopic
and other keyhole approaches are technically demanding, require specialized
instrumentation and are not appropriate for all brain tumors. Consequently,
there remains a role for conventional larger craniotomies especially when the
tumor itself has created a path through the brain or bone. Our BTC Director, Dr.
Daniel Kelly has extensive experience with both conventional and keyhole
approaches totaling over 5000 such procedures over the past 21 years. This large
experience allows us to provide a truly tailored approach best suited for each
Specific keyhole approaches are selected based on tumor type, size and location.
The endonasal endoscopic approach (via the nostrils) is used for pituitary
adenomas, craniopharyngiomas, chordomas, Rathke’s cleft cysts, sinus carcinomas,
olfactory neuroblastomas and midline meningiomas. The supraorbital eyebrow
craniotomy is used for meningiomas, craniopharyngiomas and other tumors near the
optic nerves and pituitary gland, as well as gliomas and metastatic brain tumors
in the frontal and temporal lobes. The retromastoid craniotomy (behind the ear)
is used for acoustic and trigeminal schwannomas, meningiomas, epidermoid tumors,
and tumors of the cerebellum such as hemangioblastomas and metastatic brain
tumors. The transfalcine and transtentorial approaches are typically used for
intra-axial brain tumors such as metastases and gliomas that are covered by
eloquent / critical cortex. Other keyhole & conventional craniotomies are used
for large meningiomas, gliomas (astrocytomas, ependymomas, oligodendrogliomas,
intraventricular tumors) and some metastatic brain tumors. The brain port technique
is also used for some tumors that are deep within the brain itself. This approach
which uses MRI fiber mapping and advanced navigation techniques aims to achieve a safe
trajectory to the tumor and minimizing collateral damage to surrounding brain structures.