In the past, removing a tumor of the skull base required invasive surgery. Now, with the teamwork of neurosurgeons and otolaryngologists at UT Southwestern, patients in North Texas have a minimally invasive surgical option: endoscopic skull-base tumor resection.The UT Southwestern team currently performs approximately 150 endoscopic skull-base tumor resections per year – about two to three surgeries per week, according to Bradley Marple, M.D., Professor and Chair of Otolaryngology/Head and Neck Surgery. A multidisciplinary team collaborates to perform these procedures. The team includes:
- Neurosurgery: Sam Barnett, M.D.; Bruce Mickey, M.D.; and Toral Patel, M.D.
- Otolaryngology: Bradley Marple, M.D.; Matthew Ryan, M.D.; Ashleigh Halderman, M.D.; and Barbara Schultz, M.D.
The team most commonly uses endoscopic skull-base tumor resections with patients who have pituitary adenomas. But patients with other types of tumors – such as chordomas, craniopharyngiomas, esthesioneuroblastoma, meningiomas, and sinonasal cancers – can benefit from this technique as well.
“The majority of the skull base tumors that we treat are benign, but minimally invasive approaches can be applied to selected malignancies. There are two broad categories of tumors that can be addressed endoscopically.” Dr. Marple says. “One category consists of intracranial tumors that abut the paranasal sinuses. The other category involves tumors that originate within the nose or paranasal sinuses and extend into the intracranial cavity or orbit.”
A more straightforward approach to skull-base surgery
Formal craniotomy – the traditional surgical approach for treating skull-base tumors – is complex. “The patient requires exposure of the scalp through removal of hair, an incision in the scalp, and temporary removal of a portion of the skull in order to access the intracranial cavity. Following this, a portion of the brain must be gently displaced in order for the surgeon to gain access to the tumor,” Dr. Marple says.
But UT Southwestern surgeons can remove selected tumors involving the skull-base by accessing them with an endoscope through the patient’s nostrils, along with a small opening in the skull.
Dr. Marple compares the choice between these surgical techniques to a mechanic deciding how to change a car’s oil. “Starting from the top, you could deconstruct the entire engine to get down to the oil pan, but it makes a lot more sense to lift the car up, go directly to the oil pan, and change the oil,” he says. “And that’s exactly what we’re doing here – coming right under the tumor without disturbing any of the adjacent brain.”
Patients who undergo minimally invasive skull-base surgery to remove tumors have significantly shorter hospital stays than those who have external craniotomies. After spending the first night in the intensive care unit for close observation, many patients can go home in just one to two days following surgery, Dr. Marple says. Patients with malignancies may require radiation therapy, presurgical and/or postsurgical chemotherapy, and other treatments in addition to endoscopic tumor resection.
‘Communication is key’
The referring physician is a vital part of a patient’s care team, and UT Southwestern surgeons work closely with patients’ primary care physicians throughout the process. “Communication is key,” Dr. Marple says. “In addition to communicating with the physicians on the team here on campus, we’re also in communication with the primary referring physician. And after a patient’s tumor has been managed, we’ll frequently be working directly with the referring physician for postoperative care and management."
Open communication with the members of a patient’s care team is a point of emphasis for UT Southwestern surgeons, whether they are treating a patient’s skull-base tumor or providing a second opinion. “We use electronic medical records (EMR) to keep open lines of communication across the multiple disciplines involved in our patients’ care,” says Matthew Ryan, M.D., Associate Professor of Otolaryngology. “EMR also is becoming an effective tool for us to communicate with our patients’ primary care physicians in the Dallas-Fort Worth Metroplex, and patients perceive this. They appreciate that their doctors can communicate about their care quickly and easily.”
“Physicians who refer patients for second opinion are seeking to broaden the team involved in considering treatment options for an individual patient or medical condition. In some cases, second opinions help to influence management plans to be implemented by the referring physician, while in other cases we are asked to assume a portion of the patient’s care,” Dr. Marple says. “Broadening the team of physicians involved in the care of a patient, either through consultation or transfer of care, ensures that even rare conditions benefit from the collective experience and expertise of the entire medical community. Our goal is the same as the referring physicians’: to make sure the patients receive the best available care.”