Center for Skull Base Surgery: Winter 2016

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University of Pittsburgh

Summer 2015

3000 Patients Treated at Center for Skull Base Surgery On a Wednesday in early December 2015, when James Demaria had a pituitary tumor removed endoscopically, a landmark was reached in the Center for Skull Base Surgery—James became the 3000th patient to have a tumor removed via the endoscopic endonasal surgical approach. Since the Center was formally initiated three decades ago, University of Pittsburgh surgeons have continued as trailblazers in minimally invasive procedures for brain tumors, sparing more and more patients the morbidities associated with disrupting the brain during surgery. While living and working in Ohio, James experienced a succession of perplexing health issues—he was increasingly fatigued, had gained 50 pounds over a 5-month period, and had bouts of double vision. His primary care physician

diagnosed James with stress; the antidepressants prescribed, says James, “made me feel so much worse. So my primary care referred me to a neurologist. The neurologist did numerous tests, results of which were all negative.

James Demaria

They then ordered an MRI, which clearly showed a very noticeable tumor in my brain. That led me next to a neurosurgeon who did not want to do surgery until the tumor was smaller; he was concerned with its large size and location. So, next I was referred to an endocrinologist who prescribed medications to shrink the tumor and get my hormone levels in line.” At 6-month followup, James’ tumor shrunk by 30% with no change in his hormone levels. “I was still fatigued, still couldn’t lose weight, and I still was having double vision. I was not feeling better; at 40 years old, I shouldn't have been feeling like this.” It was his parents’ health issues that ultimately led James to Pittsburgh. His mother’s diagnosis of cancer and his father’s challenges with spinal stenosis prompted James to leave Ohio to care for his parents full time at their home in West Virginia. While in West Virginia, James consulted with a neurosurgeon who directed him to Dr. Paul Gardner. “I liked Dr. Gardner right away” says James, “he was very informative. He was the first doctor I talked to who had the same thought pattern I did. Dr. Gardner felt like I did, ‘let’s get the tumor out, then get hormone levels inline.’ Dr. Gardner recalls, “James was still very symptomatic from his tumor which was not well controlled with medication. Despite the challenge of the large tumor, I felt our Pittsburgh skull base team could provide James a cure because of our extensive experience and improved outcomes with the endoscopic endonasal approach.” James reports, “I feel better—I have such a greater sense of well being – I’m not back to all activities yet. I just feel so much better; I started my new job 2 weeks after the surgery and I’m looking forward to exercising again. If I were to advise other people with my condition, I would say ‘go forward with surgery.’ 3000! That’s the number of minimally invasive endoscopic skull base procedures performed by the UPMC Center for Cranial Base Surgery, making them one of the most experienced centers in the world. The surgical team continues to develop new surgical approaches and techniques, explore new therapies, and strive to optimize outcomes for all patients. Some of the surgeons’ clinical studies are highlighted in this issue. Dr. Carl Snyderman’s slide presentation and talk on the evolution of skull base surgery can be viewed at: http://www.upmcphysicianresources.com/cme-course/cranial-base-surgery/item/2


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