Skull Base & Pituitary Tumor Program

At Hoag’s Skull Base and Pituitary Tumor Program, patients receive world-class care from a team of highly specialized experts who redefine what’s possible in neurosurgery. Our fellowship-trained neurosurgeons, otolaryngologists, neurologists, neuro-ophthalmologists, neuroradiologists, and endocrinologists collaborate to deliver the safest, most effective treatment for even the most complex tumors. With decades of collective experience, our team has helped advance minimally invasive surgical techniques, prioritizing precision, safety, and patient recovery. Most procedures are performed through tiny incisions—or even through the natural passageways of the body, such as the nostrils—reducing pain, scarring, and recovery time. At Hoag, patients can trust that they are in the hands of pioneers who combine compassion, innovation, and advanced technology to achieve the best possible outcomes and quality of life.

Skull base neurosurgery is a specialized surgical approach focused on the area at the bottom of the skull, which includes complex anatomical structures like nerves, blood vessels, and the brain. This type of surgery is often employed to remove tumors, repair abnormalities, or address conditions affecting the base of the skull and surrounding areas. It requires a high level of expertise due to the intricate nature of the region and the proximity to critical brain structures.

Techniques used in these surgeries can be either open or minimally invasive. Open surgeries involve making an incision to access the skull base, while minimally invasive techniques use endoscopes through the nose or small openings. The choice of technique depends on the location and type of the condition. The surgery aims to remove or repair the problematic area while minimizing damage to nearby critical structures like the brain, cranial nerves, and blood vessels. Advanced imaging and navigation technologies often assist surgeons in achieving precise results.

At Hoag, advanced technology meets surgical artistry. Using the Precision Virtual Reality® platform by Surgical Theater, our neurosurgeons transform traditional MRI and CT scans into an immersive 3D model of your brain. This allows our experts to study every angle of your anatomy and rehearse the procedure virtually before entering the operating room.

Patients and their families are invited to “walk the surgery” alongside their surgeon, gaining a clear understanding of where the tumor is located and how it will be safely removed. This approach not only enhances precision but also eases anxiety, turning fear of the unknown into confidence and collaboration.

During surgery, the same technology transitions into an augmented reality (AR) experience, overlaying the surgical path within the surgeon’s microscope. It’s like having X-ray vision, offering unparalleled accuracy and minimizing risk to surrounding tissue.

Hoag remains one of the nation’s highest-volume centers using AR in neurosurgery and continues to advance the field under the leadership of Dr. Louis, Empower360 Endowed Chair in Skull Base and Minimally Invasive Neurosurgery.

Surgical treatment of a pituitary tumor is often necessary when it causes any variety of hormone problems, compressing important nerves and arteries at the base of the brain, or when the tumor is putting pressure on optic nerves, bringing on loss of vision. Surgical success rates depend on the location, type and size of tumor, and whether it has spread to surrounding areas.

There are two types of pituitary surgery including the minimally invasive endoscopic transsphenoidal approach and the transcranial approach, also known as craniotomy.

Revolutionizing Preparation for Brain Surgery

Hoag became Orange County’s first and only hospital to treat neurosurgery patients using the same sophisticated software platform that powers today’s highly immersive and realistic computer games.

Developed by a company called Surgical Theater, Surgical Navigation Advanced Platform, or SNAP software blends medical imaging with the latest gaming technology and 3D virtual reality systems. The result is an extraordinarily advanced imaging tool that revolutionizes the way neurosurgeons prepare for and perform delicate cranial procedures.

Minimally invasive endoscopic transsphenoidal surgery enables the doctor to remove the tumor through the nose and sinuses, without the need for an external incision. The technique uses the nostrils as a natural portal to the pituitary gland without the need for an external incision. The doctor works through the nostrils with a tiny camera and a light called an endoscope. An opening is made in the nasal septum, sphenoid sinus, and sella to reach the pituitary. Once the pituitary is exposed, the doctor removes the tumor. Remaining areas of the brain are unaffected, and the procedure leaves no visible scar.

This procedure is conducted with a team of neurosurgeons and ear, nose, and throat (ENT) surgeons.

The vast majority of pituitary tumors can safely be removed through the endoscopic, transsphenoidal route. Exceedingly large tumors may be difficult to remove endoscopically, however, especially in cases where the tumor has spread to adjacent nerves or brain tissue. In these rare cases, a more extensive operation may be required that uses a craniotomy combined with skull base approaches.

Supraorbital eyebrow craniotomy is a safe and effective approach used to remove metastatic brain tumors, gliomas, meningiomas and craniopharyngiomas located along the subfrontal section of the brain or around the pituitary gland, which are close to the optic nerve or vital arteries. This approach requires a small incision within the eyebrow line.

For prolactinoma, surgery may not be required as this type of tumor responds well to medication and close observation with periodic MRI to monitor tumor growth.

At Hoag, we believe that exceptional care extends beyond the operating room. Our vision is to combine hospitality and healthcare, ensuring that every patient feels seen, supported, and respected throughout their journey.

Through our flagship Styled for Surgery program, patients receive personalized haircuts before surgery designed to discreetly hide incision lines, helping you return to life feeling confident and whole. You’ll also have the comfort of wearing your own clothes, skipping unnecessary pre-surgery testing the day of, and avoiding the ICU after most craniotomies.

These thoughtful touches aren’t just about comfort; they’re about dignity. By minimizing the visible and emotional impact of surgery, we help you focus on what matters most: healing and getting back to yourself.

Because at Hoag, your care doesn’t end when surgery does;it begins with how we make you feel every step of the way.