A Patient nt’s ’ Passion Encounters the Center er’s ’ Passion n 8:00 AM was the reading on the computer clock when Dr. Gary Frenette’s call came through for this interview. On the dot, precisely the appointed time for the call. Dr. Frenette laughs at the accuracy of his timeliness. “I take time seriously! I hate to keep people waiting, I always have and now even more so.” His “now” marks his crossover from doctor to patient, post tumor diagnosis and surgery. An annoying bit of nasal stuffiness did not affect Dr. Frenette’s busy medical oncology practice or his life in Charlotte, North Carolina. Its persistence led him to make an appointment with a trusted ENT colleague, who performed a physical examination, uttered “Hmmmmm,” and sent him immediately for a CT scan. Hearing the “hmmmm” from Dr. Don Kamerer, Dr. Frenette’s attitude went from casual to high alert. Dr. Kamerer came back with the scans and with a second physician. The scans showed a tumor larger than a golf ball extending through the sinuses. That same night Dr. Frenette got an MRI. “Being a doctor, I could clearly see a large mass that was not supposed to be there. Bone in my sinuses was destroyed. And I saw what looked like tumor invasion of the brain.” Being a doctor is, perhaps, not the most desirable position to be in when you can see clearly what is going on with your test results and know the potential repercussions. “I was shell-shocked. The first thing I did was make sure my affairs were in order. I believe an important role in my life is taking care of my wife and family, so I visited my attorney and confirmed that our documents were up to date. That was immediately comforting. Once I did that, I could think about my health situation.” “After a few days of thinking about medical options, trying to make decisions, I calmed down and realized I needed to treat this situation intellectually more than emotionally. I realized that I had blessings that many, unfortunately, do not. I have a medical education, I live in the best country; I can go anywhere for healthcare. So I devised a reasonable strategy for myself: In my practice, I defer to surgeons since I’m not a surgeon. I adopted this strategy as a patient. In one consultation, it sounded to me like the plan was too much cookbook and less thinking innovatively about my specific situation. As we physicians are increasingly encouraged to follow very strict guidelines, sometimes medical care seems too formulaic. One option presented to me was to proceed with a repeat biopsy and then consider open surgery that would be followed by chemo- or radiation therapy as necessary.” Frenette, with his medical knowledge, knew this tumor would be difficult to remove. “A tumor like this can’t be removed en bloc (all together as one mass) because of vital structures all around the tumors.” “Dr. Kamerer had mentioned Dr. Carl Snyderman and the procedure of endoscopic endonasal surgery performed at UPMC. Dr. Kamerer trained with Dr. Snyderman in Pittsburgh and I had sent some of my oncology patients to UPMC for minimally invasive procedures. I knew that Dr. Snyderman was an innovator and international leader in skull base surgery. So my second call to discuss options was to Dr. Snyderman’s office at UPMC. I spoke with Mary Jo Tutchko, the Center’s administrative manager, and with his surgical scheduler Susan Ezykowsky. These two ladies were wonderful; you are very vulnerable in this situation; I didn’t realize exactly how vulnerable patients were until this experience. I didn’t realize how important it was to be greeted with kindness and a smile – I felt like a VIP – simple kindness had an enormous impact, all the way from taking your vitals when you walk in to the end when you walk out.”

Gary Frenette MD, in running form, with his daughters.

“Surgery and, therefore, surgical skill is more important in skull base surgery than in almost any other type of cancer,” says Dr. Frenette. “It’s important to emphasize that I’m not a doctor worshipper, probably the opposite, so what I think about Dr. Snyderman and Dr. Paul Gardner is not gratuitous praise. The professionalism of Dr. Snyderman and Dr. Gardner was comforting and they took the time to understand and comment on every aspect of my case. They said they needed to operate on my tumor; I saw them on a Wednesday and had surgery that Friday.”

Online access to links in this issue at ISSUU U: ht U: https://issuu.com/search?q=UPMC+center+for+skull+base+surgery h ttps://issuu.com/search?q UPMC+center+for+skull+base+surgerry

A Patient nt’s ’ Passion . .

Continued from page 1

Dr. Frene e says, “I knew I had the best surgical team with Gardner & Snyderman. Prior to anesthesia, I told them that if they wondered if they needed to be more aggressive, they had my permission in advance to be as aggressive as they needed to be, that if they were 50/50 on something, to remove or not to remove, go ahead! They laughed, but I had to let them know I trusted their judgement and skills completely.” As is typical with earth-shaking events, there are a ershocks. Dr. Frene e’s personal a ershocks affected his pa ents, his life, and the Skull Base Center: “I was touched by Dr. Gardner’s and Dr. Snyderman’s passion for what they do. I saw how many people had been trained by Dr. Snyderman in this procedure. For my own procedure, I was out of the hospital in 24 hours. In fact, the first group of consultants called me to schedule a second biopsy 4 days a er the tumor had already been removed by the UPMC team. Many others recommended open surgery, a huge opening ear-to-ear in the skull. To remove these tumors with minimally invasive techniques and to educate others in the technique is a fantas c cause. It is far preferable to have this type of closed surgery, especially for children, whose skulls are s ll developing.” “I was blessed to have a favorable prognosis based on the results of my surgery, but realized that many are faced with more challenging courses. It was important to me that others have access to the same world-class care that I received.” Says Dr. Frene e, “I did the easy part of dona ng to their Surgical Simula on Center; Dr. Snyderman and Dr. Gardner do the hard work of training surgeons around the world in these techniques. Dr. Snyderman is one of the original physicians who developed techniques for this surgery and it is a great cause to teach others to do this. To have these guys share this technology and techniques totally speaks to their character as physicians. How great to be able to support a training center they run.” The Center warmly thanks Dr. Gary Frene e for sharing his medical journey, his insights as a medical oncologist, and for his financial support in helping the Center train future skull base surgeons.

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Center Expands Training with 1st Advanced Course e

UPMC Complex Endoscopic Endonasal Surgery of the Skull Base Course Members

The Center for Skull Base Surgery leaders, Dr. Carl Snyderman, Dr. Paul Gardner, Dr. Juan FernandezMiranda, and Dr. Eric Wang designed a new curriculum to teach an advanced course for skull base surgeons. The 3-day course, held in August 2017, hosted experienced skull base surgical teams who desired to refine the technical nuances of endoscopic endonasal surgery of the ventral skull base and apply endoscopic and reconstruc on techniques to complex pathologies. This inaugural advanced course hosted 40 surgeons from Brazil, Chile, China, Denmark, Ecuador, Egypt, Japan, Lebanon, Mexico, Russia, Saudi Arabia, Spain, the UK, and Vietnam.

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A Patient nt’s ’ Passion . .

Continued from page 2

“In my clinical prac ce ce, I’ve always par par cipated cipa cipat in daily 7AM mul discipl disciplinary conferences,” says Dr. Frene e. I take these very seriously since this is how we collaborate as a team and come up with comprehensive plans for our pa ents. I observed the Gardner & Snyderman team func on; they were the best, not two doctors coming together over a pa ent for the first me in the OR; they discuss everything, they cross-consult. Mul disciplinary care is cri cal in the face of skull base tumors.” “I was recalling how I put my life affairs in order as soon as I saw the tumor in my scans. In my prac ce, those are difficult conversa ons to have with pa ents. I now emphasize that aspect with pa ents and emphasize the point that all of us should have these documents completed, preferably while we are in good health. Now that I’ve been a pa ent, goals of care have become even more important to me in my prac ce. I recommend the Caring Bridge website to pa ents to tell the story of your medical journey. Everyone has their own stories; that site is a great outlet to share as li le or as much as you wish. It was a great way for me to communicate with the hundreds of pa ents and family and friends who reached out to me during my me as a pa ent.” Dr. Frenette’s wife and daughters.

Dr. Frene e concludes, “I have known thousands of physicians in a span of 30 years of training and prac ce. Dr. Synderman is among a handful of prac oners who humbly and skillfully is transforming the op ons and prognosis of this difficult disease. He is an innovator, teacher, and now, a good friend. “

Center er’s ’ Fall Training Course e

UPMC Fall 2017 Endoscopic Endonasal Surgery of the Skull Base Course Members

Over 60 surgeons a ended the Center for Skull Base Surgery Fall course in endoscopic endonasal skull base surgery. Guest Faculty invited by the Center Leaders were Dr. Griffith Harsh and Dr. Peter Hwang of Stanford University and Dr. Gustavo Noguiera of the Neurological Ins tute of Curi ba, Brazil. Surgeons came from Argen na, China, India, Japan, Panama, South Korea, and across the United States to a end the Pi sburgh Course. 3

Dr. Eric Wang and Dr. Juan Fernandez ezz-Miranda in China na Dr. Eric Wang and Dr. Juan FernandezMiranda were invited as the keynote speakers for the Na onal Skull Base Endoscopic Conference at Tangdu Hospital in Xi’an, China on April 6-10, 2017. Their live surgical demonstra on of endoscopic skull base surgery on a pa ent with a pituitary tumor was broadcast online and viewed by over 20,000 Chinese medical prac oners. The course included live anatomic prosec ons and lectures ranging from 3D anatomy to evolu on of skull base reconstruc ons. Dr. Yan Qu hosted the UPMC surgery and anatomy educators. Dr. Juan Fernandez-Miranda and Dr. Eric Wang in Xi’an China, pictured with their hosts, fellow teaching faculty, and surgical nurses.

Dr. Wang’s and Dr. Fernandez-Miranda’s surgical demonstra on and anatomic lectures at the Skull Base Conference provided them a unique teaching opportunity and bu ressed the efforts of Tangdu teaching hospital to become one of the top general research-oriented academic hospitals in China.

Dr. Wang and Dr. Fernandez-Miranda at the Terracotta Warriors exhibit .

While in China, Dr. Wang and Dr. Fernandez-Miranda were given a tour of the Terraco a Warriors exhibit in the mausoleum of the first Chinese emperor, located about 20 miles from Xi’an. The approximately 8000 hand-carved statues occupy only one area of the Emperor Qin Shi Huang Di’s massive tomb complex. Since the 1974 accidental find of the statues, archaeologists have unearthed graves and addi onal carved figures. Scien sts using radar and core sampling have revealed the emperor’s en re tomb complex to comprise 20 to 30 square miles.

To put the size of this World Heritage Site into perspec ve, the major metropolitan area of Pi sburgh is typically calculated as 55 square miles (inset on right). Dr. Wang concludes, “Dr. Qu and the en re skull base team at Tangdu Hospital were amazing hosts, providing us the opportunity to experience the culture of this dis nct province in China and teach in their hospital. The terraco a warriors tour was an unforge able sight and a highlight of the trip.” 4

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Dr. Eric Wang and Dr. Juan Fernandez ezz-Miranda in Spain in In June 2017 2017, Dr. D Juan J FFernandez-Miranda d Mi d and d Dr. D EEric i Wang W were iinvited it d ffaculty lt att C Course II off EEndoscopic d i Endonasal Surgery of the Skull Base in Madrid, Spain. The two UPMC surgeons teamed to perform a live surgery to remove a suprasellar dermoid and instruct physicians in the procedure via remote, online access. In addi on to the surgery and lectures, a course in 3D anatomy was presented by Dr. Fernandez-Miranda and an innova ve course in microsurgical endoscopy in laboratory animals was presented by Dr. Fernandez-Miranda and Dr. Wang. The duo was invited by the Cranial Base Surgery Course Directors of University Hospital La Paz, Dr. Julio Garcia-Polo, Dr. Alvaro Zamarron, Dr. Carolina Alfonso, and Dr. Carlos Perez Lopez. Right: Dr. Fernandez-Miranda and Dr. Eric Wang, center, flanked by two of their hosts, Dr. Carolina Alfonso and Dr. Jose Maria Roda of University Hospital La Paz.

Above: Microsurgical endoscopy in La Paz lab.

“This was a special visit for me,” says Dr. Fernandez-Miranda, “I lived in Madrid un l I was 28 years old and did my residency training at University Hospital La Paz from 2001 to 2006. To learn, a er we returned to Pi sburgh, that 20,000 physicians viewed the procedure we did while there was amazing.” La Paz University Hospital is consistently ranked the number 1 hospital in Spain, and the microsurgical endoscopy course on live animals that Dr. Fernandez-Miranda helped direct is the first of its kind ever done in the Western hemisphere.

Dr. Paul Gardner and Dr. Carl Snyderman in Russia ia

Top: Dr. Carl Snyderman and Dr. Paul Gardner lecture to physicians in Kazan, Russia. Bottom: Following live surgery televised to Kazan attendees in the conference room, the surgeons face a media crush with their host, Dr. Bakhityar Pashaev.

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Center for Skull Base Surgery University of Pittsburgh 203 Lothrop Street Suite 500 Pittsburgh, PA 15213 Directors: Paul A. Gardner, MD gardpa@upmc.edu Carl H.Snyderman, MD snydermanch@upmc.edu

In future newsletters, you will learn more about new clinical, research, and educational projects initiated at the Center for Skull Base Surgery. Your support is essential.

If you would like to learn more about our activities or sponsor a project, please contact the Eye & Ear Foundation.* To support the Center for Skull Base Surgery, please use the enclosed envelope or visit eyeandear.org. If sending a check, please make payable to the Eye & Ear Foundation.

The University of Pi sburgh Skull Base Team is pictured above. Addi onal informa on about the educa onal and clinical work of the Surgeons of the Center for Skull Base Surgery is found at: UPMC.com/skullbasesurgery

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