Dr. Charles Wilson, One of the world’s greatest neurosurgeons and pioneer of transsphenoidal pituitary surgery died at 88

 

The UCSF website in an obituary from Kate Vidinsky reads “He took a particular interest in pituitary disorders, those affecting the pea-sized ‘master gland’ at the base of the brain responsible for controlling the body’s hormone levels. He was a pioneer of transsphenoidal surgery – the endonasal approach for removing pituitary tumors – and performed more than 3,300 of these procedures at UCSF Medical Center.”

The New York Times in an obituary published yesterday described him as “a pioneering and virtuosic San Francisco neurosurgeon”.

Dr. Wilson died February 28, 2018.

Pituitary Gland Resection May Help Manage Presumed Cushing’s Patients

 

The surgical removal of two-thirds of the pituitary gland is associated with high initial remission rates and low operative morbidity in patients with suspected Cushing’s disease, when no tumor is found on the gland during surgical exploration.

Cushing’s disease (CD) is caused by increased levels of glucocoticosteroids, such as adrenocorticotropic hormone (ACTH), circulating in the blood.

In nearly 70 percent of cases this happens as a result of benign tumors on the pituitary gland, which produce excess ACTH. In these patients, the most effective and first-line treatment is surgical removal of the pituitary gland tumor.

During the diagnostic stage, clinicians use several methods to identify and localize the source of excessive ACTH. But these methods can fail, and the presence of a tumor in the pituitary is not always confirmed. If the tumor remains unidentified during surgical exploration, it falls to the surgeon’s discretion about how to manage their patients.

Researchers at the University of Colorado Denver School of Medicine provided an overview of their experience on the management of patients with presumed Cushing’s disease who underwent surgical treatment.

The study, “Negative surgical exploration in patients with Cushing’s disease: benefit of two-thirds gland resection on remission rate and a review of the literature,” was published in the Journal of Neurosurgery.

“The diagnosis and treatment of CD is one of the most challenging entities that pituitary neurosurgeons, endocrinologists, and pathologists face,” the researchers wrote. “The ability to make a correct diagnosis and deliver a high likelihood of remission after surgery relies heavily on the performance of a meticulous workup and rational surgical strategy.”

The team retrospectively analyzed all cases that had been referred to the Department of Neurosurgery of CU School of Medicine between 1989 and 2011 for a potential ACTH-secreting pituitary tumor.

During this period, 161 cases of Cushing’s patients who underwent surgical tumor resection were reported. In 22 patients, the surgeon was unable to detect a tumor.

In these cases the surgical team decided to remove two-thirds of the gland, with resection of the lateral and inferior portions of the pituitary. All 22 patients were treated using a consistent technique performed by a single surgeon.

Posterior tissue analysis confirmed that six of these patients had pituitary ACTH-secreting tumors. In the remaining 16 patients, no tumor was identified. In three patients the team believed that overproduction of ACTH could be due to an overgrowth of ACTH-secreting cells rather than expansion.

The team believes that these findings underscore the difficulty of accurately diagnosing very small pituitary tumors pre- and post-operatively.

The 22 patients were followed for a mean time of 98.9 months, or 8.2 years. No remissions were observed in the six patients who had ACTH-secreting tumors or in 12 of the remaining patients. Blood analysis in follow-up exams confirmed these patients had normal levels of glucocoticosteroids.

Four patients continued to show persistent elevated amounts of ACTH. Additional clinical evaluations revealed that two patients had ACTH-secreting lung tumors, and one patient was suspected of having an ACTH-secreting tumor on a brain region close to the pituitary. There was one case where the clinical team was unable to identify the origin of elevated ACTH.

Only three patients required hormone replacement after the two-thirds gland removal to overcome a newly detected hormone deficit. The approach used by the surgical team was, overall, found to be safe with no severe side effects reported.

“Currently, when the neurosurgeon is faced with the inability to identify a discrete adenoma intraoperatively, there is little uniformity in the literature as to how to proceed,” the team wrote. “We believe this [pituitary resection] approach will be useful to help guide surgeons in the operative treatment of this particularly difficult group of patients.”

From https://cushingsdiseasenews.com/2017/12/14/pituitary-gland-resection-may-help-presumed-cushings-disease-patients/

Pituitary tumors require collaborative care for best treatment results

A statement released by the Pituitary Society outlines criteria for developing pituitary tumor centers of excellence and asserts that the best care for patients comes from a collaboration of endocrinologists and experienced pituitary surgeons.

“Such a core team needs to be supported by a collaborative environment of specialists in other areas, such as neuroradiology, neuropathology, radiation oncology, neuro-ophthalmology, otorhinolaryngology, plus trained nursing,” the authors wrote.

Felipe F. Casanueva, MD, PhD, professor of medicine in the department of medicine, endocrine division at Santiago de Compostela University in Spain, and nine other experts served as a task force to develop the statement.

The authors wrote that goals of the collaborative team should include the following:

  • detecting the tumor early;
  • diagnosing the tumor;
  • determining the most suitable treatment, whether observation, surgical, medical or radiotherapy;
  • removing the pituitary mass and preserving normal pituitary tissue, if surgical treatment is needed;
  • using treatments that eliminate hormonal hypersecretion and/or its effects;
  • preventing tumor recurrence; and
  • recognizing and caring for delayed complications.

“The final goal is the elimination or at least reduction of the excess morbidity and mortality associated with the tumor and hypersecretion syndrome as well as treatment of accompanying pituitary hormone insufficiencies,” the authors wrote. “For many patients, this requires a program of care, including medical therapy, surgery and radiation therapy, in addition with long-term follow-up.”

Further, pituitary tumor centers of excellence should be patient-centered and focus on engagement activity, family impact, educational platforms and digital infrastructure to facilitate care across specialties.

“In the last few decades, a considerable body of evidence supports the concept that patients with pituitary tumors would receive the best care from units of excellence composed of expert neurosurgeons performing pituitary surgery by transsphenoidal and other approaches, plus experienced neuroendocrinologists devoted to these types of tumors,” the authors wrote. “These experts, working in liaison with supporting units, would form a center of excellence for pituitary tumors (PTCOE). Such a center would be the optimal organization for patients, the most cost-effective for health administrators, and a more suitable structure to allow for derivation and presentation of results, and advancement of pituitary science.” – by Amber Cox

Disclosures: Casanueva reports he is a consultant and receives lecture fees from Novo Nordisk, Orexigen and Pronokal and is a member of the board of directors of the Pituitary Society. Please see the study for all other authors’ relevant financial disclosures.

From https://www.healio.com/endocrinology/neuroendocrinology/news/in-the-journals/%7B94d60bd1-9b48-4da4-b54f-fce7fea5b7df%7D/pituitary-tumors-require-collaborative-care-for-best-treatment-results

Massachusetts Hospital Opens New Neurosurgery Program

Please let us know your experiences with this new program!

 

Hallmark Health and Tufts Medical Center have established a new neurosurgery program at Melrose-Wakefield Hospital to bring advanced care and services to the community. Fellowship-trained neurosurgeon Mina G. Safain, MD, has been jointly hired by Hallmark Health and Tufts Medical Center to lead the new program. He will provide care at both Melrose-Wakefield Hospital and Tufts Medical Center.

The neurosurgery program is an example of clinical integration of services between Hallmark Health and Tufts Medical Center since Hallmark Health joined Wellforce as a third founding member this past January. At that time, leaders from the organizations discussed finding ways to bring specialized care traditionally performed at academic medical centers into the community hospital setting for the benefit and convenience of patients.

“Offering neurosurgery provides a service for our patients that few community hospitals can offer,” said Steven Sbardella, MD, chief medical officer at Hallmark Health. “Our clinical relationship with Tufts Medical Center enables us to bring more highly specialized care options to our patients.”

“We are extremely excited to work with the physicians at Melrose-Wakefield Hospital and look forward to increasing the services available to care for patients with neurologic diseases,” said Carl Heilman, MD, neurosurgeon-in-chief at Tufts Medical Center. “Dr. Safain is an exceptionally talented and compassionate neurosurgeon and the perfect person to spearhead the launch of this new program.”

Dr. Safain’s clinical interests include all diseases affecting the brain, spine and peripheral nervous system.  He has specific interests in minimal access procedures for degenerative, infectious and oncologic spine disorders, as well as minimally invasive treatments for brain tumors, including neuro-endoscopy.

“The opportunity to practice in the community is very important to me,” said Dr. Safain. “I look forward to working with the esteemed staff and providers at Melrose-Wakefield Hospital and Lawrence Memorial Hospital and treating the patients in the surrounding communities.”

“Welcoming such a highly-respected neurosurgeon as Mina Safain to our team is a tremendous benefit for our communities and patients across our system including Lawrence Memorial Hospital in Medford and Melrose-Wakefield Hospital,” said Dr. Sbardella.

Dr. Safain, together with Ran Ku, PA, a neurosurgery physician assistant with more than 12 years of experience, will provide neurosurgery coverage and expertise five days a week.

Dr. Safain received his medical degree from Yale University School of Medicine.  He completed his neurosurgery residency at Tufts Medical Center serving as chief resident during his final year.  Dr. Safain also completed fellowship training in pituitary and neuro-endoscopic surgery at Brigham and Women’s Hospital.

Dr. Safain has published and presented nationally on a range of topics related to neurosurgical diseases and minimally invasive treatments for brain tumors.

From https://www.hallmarkhealth.org/Neurosurgery-program-established-at-Melrose-Wakefield-Hospital.html

Neurosurgeon and Otolaryngologist Team Up to Remove Tumor in Pituitary Gland

After experiencing bad headaches and double vision, Kris Johnson was diagnosed with a pituitary adenoma, a tumor of the pituitary gland at the base of the brain. Loyola ENT surgeon Chirag Patel, MD, teamed up with neurosurgeon Anand Germanwala, MD, to remove the tumor, and Ms. Johnson now is “100 percent back to normal.”

Article ID: 668877

Released: 3-Feb-2017 2:05 PM EST

Source Newsroom: Loyola University Health System

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