Brain Tumor Procedure Restores Patient’s Vision

Minimally invasive surgery makes difference for John Taylor

John Taylor and his wife prepare a Thanksgiving meal after minimally invasive surgery to remove a brain tumor restored his vision. SD Health Magazine

Minimally invasive surgery makes difference for John Taylor

Like most people who undergo cataract surgery, John Taylor expected to see better after the procedure. Instead, the day after having his left eye corrected in February 2022, the 78-year-old noticed blurring in his peripheral vision. He saw his ophthalmologist several times and had a cataract in his right removed a few months later, but the blurriness persisted. 

“Finally, on yet another visit, a different doctor said it might be caused by a growth on my brain. It was the first time anyone had suggested that,” Taylor says. “My optometrist told me I needed to see a neurologist as soon as possible.” Taylor reached out to his primary care physician at Scripps about his test results and was quickly referred to neurology. 

“The scheduler I spoke to was phenomenal,” he recalls. “She had all my tests set up within 10 days.” 

Unfortunately, those tests revealed a much more complicated problem: a tumor on his pituitary gland that was pressing on his optic nerve. He was referred to Jeremy Ciporen, MD, a new neurosurgeon at Scripps Clinic Rancho Bernardo who specializes in skull base surgery.

“Being told you have a tumor is scary. But Dr. Ciporen sat with my wife and me and showed us illustrations alongside my CT and MRI results. He explained exactly where and what the mass was, and what the surgery would entail,” Taylor recalls. “He was very patient and detailed; he took my anxiety level and dropped it down significantly. You’d never meet a nicer man.” 

Brain tumors and vision loss

Dr. Ciporen explains: “Mr. Taylor had a giant pituitary adenoma. It was much larger than the average pituitary tumor. It had displaced his normal pituitary gland as it grew upward into the brain. The tumor compressed both optic nerves resulting in Mr. Taylor’s dense visual field deficit. His peripheral vision was blacked out on both sides as a result of the tumor’s pressure on these nerves.” 

The pituitary gland is located below the brain and above the nasal passages. Despite being about the size of a pea, it is the “master gland” in the body and controls many functions and hormones. 

Pituitary tumors can crowd out normal cells in the sella turcica, the small chamber that envelopes the pituitary gland. A large tumor in this area can press upon and damage the brain and nerves. Vision changes or headaches are common symptoms; in a number of patients, hormones can also be affected. 

Expert neurosurgical care

Dr. Ciporen collaborated with Chris Bergeron, MD, an otolaryngologist and skull-base surgeon at Scripps Clinic Torrey Pines and Scripps Clinic Rancho Bernardo, to come up with a care plan. 

“Mr. Taylor presented with tunnel vision — imagine looking at the world through a paper towel roll,” Dr. Bergeron says. “This type of visual loss may progress gradually, so some patients that have a tumor growing over time do not realize what they are missing until they are unable to see the shoes on their feet!” 

This may explain why Mr. Taylor did not notice the peripheral vision loss until his vision did not improve with cataract surgery. “Reviewing the MRI and CT scan was really the a-ha moment. That is when it became time for the skull base surgery team to be involved,” Dr. Bergeron continues.

“We used an entirely endoscopic technique to remove the tumor. This method has really shifted the course of anterior, skull base surgery during the past two decades.

“We’ve moved from cutting open the skull with an ear-to-ear incision and putting it back together with screws, sutures and staples, to instead accessing the tumor through the nose and some cases, through the eye socket.” 

Leading-edge technology

In Taylor’s case, Dr. Ciporen and Dr. Bergeron worked together to remove the tumor utilizing this minimally invasive endoscopic approach via his nostrils. This technique is applied to pituitary and other skull base tumors and that is new to the Scripps system thanks to Dr. Ciporen’s recent arrival. 

“It is a bit of a dance intra-operatively to take out the tumor and then perform the reconstruction, but at this point in our careers, Dr. Bergeron and I are very experienced in our respective specialties, and in planning and communicating our goals of care,” Dr. Ciporen says. 

Dr. Ciporen also credits the neurosurgical team who joined them in the operating room — nurses, scrub technicians and an anesthesiologist who specializes in neurosurgery cases. 

“The teamwork, experience, fellowship training and chemistry that Dr. Bergeron and I have is unique to find in community medical centers,” he says. “It’s a real strength of our program.” 

Another strength lies in Scripps’ commitment to expanding its neurosurgical offerings, adds Dr. Ciporen. 

“Thanks to the investment Scripps has made in upgrading neuro-navigation and pre-operative software, advanced imaging and state-of-the-art endoscopic instruments, we are able to work both independently and together during the surgery to see around corners that we would not be able to see with regular microscopes. This allows us to remove even very large tumors like Mr. Taylor’s safely,” he says. 

The innovation offered at Scripps and the expertise and attentiveness of the entire team made Taylor feel optimistic every step of the way. 

“I’m the type of person who just wants to get things done,” he says. “I went in the day of the surgery, and I didn’t feel anxious at all. I had answers to all my questions, and I felt very comfortable with everyone I met in pre-op. The next thing I knew, it was five hours later, I woke up in the ICU with the miracle-worker nurses they have there, and I could see immediately. One minute you’re on the table, and the next you’re awake and can see wall-to-wall.” 

Vision restored

Vision restored

“Overall, I feel great. I have no limitations, and I am blessed that I had the doctors and all the staff at Scripps — everyone from the schedulers to the MRI, EKG and X-ray techs, and the nurses to the food service staff. Yes, the doctors perform the surgery, but everyone puts together the end result. I felt like I was their number one concern, and I knew I was in excellent hands.” 

John Taylor

Taylor’s surgery was a success. His vision was restored and within a few days, he was able to return home — just in time for Thanksgiving. 

“I was even able to carve the turkey!” he says. 

“Mr. Taylor had a great result,” Dr. Bergeron says. “The beauty of this approach is that it allows patients to be up and walking around more quickly, feeling better and in general recovering at a faster pace. In Mr. Taylor’s case, as soon as we removed the tumor, it decreased the pressure on the optic nerve. This allowed his vision to be restored.” 

In addition to being able to celebrate Thanksgiving with his family, Taylor says he had a lot to be thankful for. Though he still sees an endocrinologist due to the pituitary gland’s job of regulating hormones, the acute vision problems caused by the tumor remain a thing of the past. 

“My vision is fantastic! My golf game may be a bit off, but I just tell people that’s because I had a brain tumor,” he jokes. 

“Overall, I feel great. I have no limitations, and I am blessed that I had the doctors and all the staff at Scripps — everyone from the schedulers to the MRI, EKG and X-ray techs, and the nurses to the food service staff,” he concludes. “Yes, the doctors perform the surgery, but everyone puts together the end result. I felt like I was their number one concern, and I knew I was in excellent hands.” 

San Diego Health Magazine Winter 2023 Cover

This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.

Related tags: