Team Approach to Skull Base Surgery Provides Comprehensive Expertise
May / June 2005
Penn's Comprehensive Center
for Cranial Base Surgery is on the cutting edge of microsurgery
and endoscopic surgery, according to co-directors Bert
W. O'Malley Jr., MD, chair, Department of Otorhinolaryngology,
co-director of the Head and Neck Cancer Center and professor
of Otorhinolaryngology and M.
Sean Grady, MD, professor and chair, Department of Neurosurgery
at the Hospital of the University of Pennsylvania.
“We
have state-of-the-art image-guided surgical instrumentation,
and we have multiple top surgical navigation systems in our
facility here at the Hospital of the University of Pennsylvania
in Philadelphia,” says Dr. O'Malley. “This technology
enhances safety and accuracy as well as our ability to provide
truly comprehensive services using minimally invasive techniques.”
Appropriate candidates for treatment at Penn’s Comprehensive
Center for Cranial Base Surgery include patients with brain
tumors that derive from the bone, paranasal sinuses, nasopharynx,
inner ear, dura, cranial nerves or brain. The lesions may
be primary tumors and may invade local structures, or they
may represent metastatic disease. Patients diagnosed with
malignant tumors including metastatic lesions to the bone,
as well as those diagnosed with benign tumors include meningiomas,
schwannomas, pituitary tumors and osteomas, should be considered
for treatment at the Center.
Few facilities address all of the diverse and extensive needs
of skull base tumor patients from diagnosis to treatment and
rehabilitation, which makes Penn’s Comprehensive Center
for Cranial Base Surgery unique. “Skull base centers
are emerging at a lot of facilities, but few have the breadth
and depth of what we have to offer here at Penn. We have the
strongest and latest diagnostic imaging equipment, and will
soon exceed even that with the addition of one of the most
powerful MRI scanning systems available with a 3 Tesla magnet,
as well as a new positron emission tomography (PET) CT, which
will add to our already expert imaging armamentarium,”
says Dr. O’Malley.
“What’s more important is
that we have the strongest pathologists, neuro-radiologists
and nuclear imaging experts on our team including Abass
Alavi, MD, a pioneer in the development of PET scan technology.” Dr.
Alavi is chief of the Nuclear Medicine Section at the University
of Pennsylvania Health System and a professor of Radiology
at the Hospital of the University of Pennsylvania. This team,
Dr. O’Malley points out, provides subtle expertise
in differentiating tumors based on MRI, CT and PET scan. “It’s
the subtleties that make the difference in skull base surgery,” says
Dr. O’Malley. Treatment Options
The aim of the center is to treat the whole patient not just
the tumor, and teamwork is critical to the plan’s
efficacy. “Our team is made up of many specialists
starting with a strong surgical team comprising neurosurgery,
otorhinolaryngology–head and neck surgery, and reconstructive
surgery colleagues. Medical oncologists specializing in
chemotherapy and radiation oncologists are also a part
of the team,” say Dr. Grady. “Every one of
these physicians plays an integral role in the management
of the skull base surgery patient.”
To further ensure the Center’s comprehensive nature,
a new Gamma knife unit will soon augment Penn’s radiation
capabilities in the fall. This device, based at Pennsylvania
Hospital, produces focused beams of radiation directing less
radiation to any one of the nerves and veins of the brain
and spinal column. This reduces the possibility of injury
from high-dose radiation exposure.
“We use computer
imaging to map out the tumor where it’s sitting by
the brain or the carotid artery or the eye and deliver high-dose
radiation to minimize the impact to these critical structures,” explains
Dr. Grady. The images can be exported on a CD-ROM, so the
referring physician can receive pre-op or post-op images
for reference and follow-up.
Penn has also been instrumental in developing imaging compounds
used in PET scans. “EF5, which helps us discern the
activity and oxygen level in skull base tumors, was developed
right here in our radiation oncology department,” says
Dr. Grady. “So not only do we have top notch imaging
technology and nuclear imaging experts, we are actually pioneering
the agents that help us light up the tumors or show how aggressive
they are, which can predict outcome or treatment stratification.”
Importance of Rehabilitation
Rehabilitation remains critical to the patient’s overall
success following skull base surgery. There are serious risks
from both the radiation and the surgical treatment to vision,
speech, swallowing, balance and hearing. “We’re
integrated with our voice specialists, who can rejuvenate
the voice or deal with swallowing issues that can occur following
treatment. We have hearing experts who can rejuvenate hearing
in a variety of ways including the use of state-of-the-art
cochlear implants. We have balance testing and rehabilitation
efforts in our vestibular center and a close working relationship
with Penn’s Department of Physical Medicine and Rehabilitation,
where physical therapists work with our patients on speech,
swallowing and balance in an effort to get these people back
to functional life and, hopefully, work,” says Dr.
O’Malley.
Reconstruction is often key to rehabilitation, and is part
of what Dr. O’Malley calls the “one-stop-shopping”
benefit of treatment at the Comprehensive Center for Cranial
Base Surgery. “The reconstruction surgeons are also
integrated with our team. We do it all in one step, in one
surgery,” he says.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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