Over the last few decades, there has been a dramatic shift in the standard of care for pituitary surgery with the introduction of endoscopic techniques. The UPMC Center for Skull Base Surgery has been a pioneer and leader in the development of these techniques and has performed over 4,000 endoscopic skull base procedures. Since the introduction of the endoscopic endonasal approach, more than 1,400 pituitary surgeries have been performed at the UPMC Pituitary Center, and our surgical team, consisting of Paul Gardner, MD, and Georgios Zenonos, MD, from neurosurgery, and Carl Snyderman, MD, MBA, and Eric Wang, MD, from otolaryngology, currently performs around 100 operations for pituitary tumors every year (over 900 since 2009). In addition, the Pituitary Center is also led by a dedicated neuro-endocrinology team of Pouneh K. Fazeli, MD, (director) and Hussain Mahmud, MD, who specialize in patients with pituitary-related hormone deficiencies or over-production.
Numerous studies now show better outcomes and lower complication rates in centers with more experienced pituitary surgeons. This experience–outcome effect is likely more pronounced in complex cases such as invasive adenomas, reoperations for recurrent adenomas, giant pituitary adenomas, Cushing’s disease, and acromegaly.
As a result, the Pituitary Society has proposed consensus criteria for pituitary centers of excellence (PCOEs), including a baseline requirement of 50 surgical cases per year. In addition, multidisciplinary care via a center of excellence model has been espoused and its advantages well described, even leading to a call for accreditation for PCOEs. Based on the above, combined with UPMC’s longstanding expertise and major role in the development of endoscopic pituitary surgery, it is logical that UPMC create a system-wide pathway of care for pituitary tumors. This has led to formation of official pituitary center of excellence criteria within UPMC and recognition of COE status for our skull base center surgeons. In addition, in conjunction with co-surgeon/pediatric neurosurgeons, the Center for Skull Base Surgery is the only group with expertise in pediatric skull base surgery and performs pediatric pituitary surgeries at UPMC Children’s Hospital of Pittsburgh.
All physicians on the current pituitary COE team are subspecialty trained. The UPMC Pituitary Center is a multidisciplinary team which includes: neurosurgery, endocrinology, otolaryngology, neuro-ophthalmology, neuroradiology/head and neck radiology, endovascular neurosurgery, radiation oncology (including Gamma Knife radiosurgery), neuroanesthesia, neuro-oncology, and neuropathology. As one of the leading centers for pituitary tumors worldwide, our triple mission is to provide comprehensive care and support to patients with pituitary disorders; to provide residency and fellowship training, as well as continuing medical education in the management of pituitary and neuroendocrine disease; and to contribute to basic science and clinical research in pituitary disorders. As a result of this collaboration, UPMC has become a regional, national and international center for referral.