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Jill’s Story: Teaming Up for Minimally Invasive Removal of a Pituitary Tumor

When a pituitary tumor returned after being removed 20 years ago, Jill joined the ranks of patients who have benefited from the teamwork of affiliated neurosurgeon Spiros Blackburn, M.D., and rhinologist William Yao, M.D. The two specialists work together at Memorial Hermann-Texas Medical Center to ensure a smoother road to recovery and improve outcomes for patients with pituitary and skull base tumors and disorders.

Painful to the Touch

Jill first noticed a problem more than a year ago, when the skin on her forehead and scalp hurt to the touch. Not long afterward, she developed a severe round-the-clock headache on the right side. After seeing a series of doctors with no relief, Jill self-referred to affiliated neurologist Courtney Preston, M.D., who practices at Patient Centered Neurology at Mischer Neuroscience Associates.

“At first she thought it might be trigeminal neuralgia,” says the 59-year-old. “When she saw the results of the MRI, she told me the good news is it’s not trigeminal neuralgia. The bad news is your pituitary tumor is back, and it’s large.” Dr. Preston referred her to the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center, where she was seen by neurosurgeons Dong Kim, M.D., director of the Institute, and Dr. Blackburn, who specializes in cerebrovascular and skull base surgery and has special expertise in both endoscopic and endovascular neurosurgery.

A Team Approach

An associate professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth, Dr. Blackburn joined the faculty after completing a cerebrovascular fellowship at Emory University in Atlanta and a neurointerventional/endovascular fellowship at Mallinckrodt Institute of Radiology at Washington University in St. Louis. “Some neurosurgeons do pituitary cases by themselves, but Dr. Yao and I tend more toward the team approach,” he says. “Our surgical skill sets overlap. Dr. Yao does an excellent minimally invasive approach through the nose and has expertise with the endoscope. For the first part of the surgery I assist. We arrive at the sella together, and then I take over as the primary surgeon and he assists during the tumor resection. Then I assist again while he closes. My fellowship training gives me a great familiarity with transsphenoidal and anterior skull base approaches, which is important, but partnering with Dr. Yao is extremely valuable in complex cases. I can ask him, if we use a particular approach for better exposure, how will it impact the patient’s recovery?”

Working together, the two surgeons were able to remove most of the tumor. After Dr. Blackburn removed as much as possible, Dr. Yao reconstructed the barrier between the brain and the nose.

“It was an incredibly delicate surgery, and it went very smoothly,” Jill says. “I spent 24 hours in the Neuroscience ICU and then a couple more days in the hospital due to diabetes insipidus, which caused my sodium level to tank. When my sodium reached an acceptable level, I was discharged.”

Like a Symphony

In the year that the two surgeons have worked together, they’ve collaborated on dozens of procedures. “We’re in sync,” says Dr. Yao, an assistant professor in the department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School. “We augment each other’s surgical skills and expertise. I create a favorable approach that allows Dr. Blackburn the access he needs to remove the tumor. Because of the frequency with which we operate together, we know each other’s moves. It’s harmony between two specialties, like a symphony with multiple instruments. While our knowledge sets overlap, they’re completely different. Our partnership is such that if there is something that concerns either of us, we can drop in and help each other out at any time.”

Jill will undergo Gamma Knife® radiosurgery in the future. “We remove as much of the tumor as possible with the patient’s safety in mind,” Dr. Blackburn says. “Any residual tumor tends to respond well to treatment with the Gamma Knife.”

Jill is grateful to both her surgeons. “Thanks to them, my life is back to normal,” she says. “I have much more energy than I had before the surgery, I’m able to do things I enjoy again and finally feel like I can move forward with my life.”