Over the course of the past 30 years, the neurosurgeons at the University of Southern California Keck School of Medicine have taken a leadership role in the treatment of complex tumors in the sellar and parasellar region of the anterior skull-base at both the national and international levels. These efforts have enabled us to develop the largest surgical experience in the management of these lesions in the Western United States. Indeed, our surgical experience currently exceeds over 3000 cases operated via the transnasal approach. In addition, a large surgical experience through the transcranial approach has also been compiled. In conjunction with endocrinologists both in the community and at USC, an equally large number of patients have been successfully managed by nonoperative strategies. Concurrent development of the latest methods in stereotactic radiosurgery at USC have resulted in the integration of this important adjuvant routinely in very complex tumors for which complete resection is associated with very high risk.

Pituitary and Sellar/ Parasellar Tumors

Those tumors that affect the sellar/parasellar regions includepituitary tumors, craniopharyngiomas, Rathke’s cleft cysts, meningiomas, and other less common neoplasms and inflammatory processes. Sellar/parasellar lesions can present with neuroendocrine abnormalities due to hypothalamic/pituitary failure or secretion of hormones by functional tumors, or with visual loss due to mass effect on critical neurovascular structures. The neurosurgeons at USC have developed an extensive experience with the diagnosis and evaluation of all lesions that affect this complex area of the human brain and skull-base.

Multidisciplinary Approach

At USC, pituitary and sellarparasellar tumors are managed with a multidisciplinary approach that involves neurosurgery, endocrinology, neuro-opthalmology, stereotactic radiosurgery, diagnostic radiology, interventional neuroradiology, radiation oncology, and pathology that take advantage of the resources of the Keck School of Medicine as well as the community. Patients undergo an extensive neuroendocrine work-up. Appropriate diagnostic imaging studies are completed, along with a full neuroopthalmologic evaluation when indicated. Once a lesion has been characterized in this manner, the best operative and non-operative treatment strategy is outlined. This may include surgery via the trans-nasal or transcranial routes and/or medical, stereotactic radiosurgical, and radiation approaches. The most modern and advanced techniques and equipment are used in all stages of treatment. The patients are followed closely for recurrent disease by both the neurosurgeons at USC, referring physicians, as well as by other physicians at USC as appropriate.