The doctors – yes, both of them – will see you now.
Several hundred patients with pituitary or skull base tumors have benefited from a new collaboration between the Department of Neurosurgery and the Division of Otolaryngology that brings specialists from both areas to the bedside and clinic.
In addition to combining their expertise and experience, they have become physically closer as well. Over the past several months, the Neurosurgery team restructured its clinical space in the Building for Transformative Medicine (BTM) to better serve this group of patients. This includes installing equipment used by otolaryngologists, also known as ear, nose and throat (ENT) specialists, in a few of the Neurosciences Center’s exam rooms.
On Mondays, neurosurgeons see patients in the Neurosurgery clinic while surgeons from Otolaryngology, which part of the Department of Surgery, hold their clinics in adjoining suites. This format enables joint visits – scheduled or spontaneous – with both specialists in the same location at the same time. The setup provides a better overall experience for patients, said neurosurgeon Ian Dunn, MD.
“A patient may come to the Neurosurgery clinic for an appointment, and, after reviewing a case, we realize having one of our ENT specialists join us would be ideal,” Dunn said. “That can happen in real time rather than after scheduling a visit in another two weeks. It can be difficult for patients to return for multiple appointments, so we’re trying to deliver everything on site at once.”
The two teams are in the process of formalizing their collaboration to establish the Center for Pituitary and Skull Base Surgery in the BTM, said Dunn, who will direct the new center.
“Working alongside each other rather than independently – and combining our collective experience from literally thousands of surgeries – results in better care for our patients,” Dunn said.
Overlapping Anatomy and Expertise
The joint team focuses on removing tumors located at the interface of the brain and the head/neck region, such as those in the pituitary gland, mid-face, deep ear canals, eye sockets or cheek bones. Examples of these include pituitary adenomas. which grow in the pituitary gland, and acoustic neuromas, which affect nerves in the inner ear that control balance and hearing.
“The anatomic intersection of neurosurgical disease and ENT-based pathologies is a natural fit for this type of collaboration,” said Ravindra Uppaluri, MD, PhD, chief of the Division of Otolaryngology.
“If there is a part of the procedure that involves a neurosurgical component, having neurosurgeons participate is critical,” he added. “Likewise, if neurosurgeons are working in an area outside of the brain, ENT expertise is as valuable. It’s a brilliant collaborative approach.”
The collaboration also includes radiation and medical oncologists and ophthalmologists, since some patients may have unique ophthalmic or auditory complications, or may need radiation or chemotherapy.
A major component of the joint surgical effort includes an emphasis on minimally invasive approaches, including transnasal endoscopic surgery, where surgeons take advantage of the anatomy of the sinuses and use image guidance to remove tumors through the nose.
“This endoscopic technique has come to be the major approach to some of these difficult tumors, and we now do almost all of these surgeries in conjunction with our ENT colleagues,” said Edward Laws, MD, director of the Pituitary and Neuroendocrine Program in Neurosurgery.