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Skull Base Brain Tumor Research




Summer 1998 Update
By Richard Suh, M.D.

Current Research at the Skull Base Institute

There have been many exciting developments in the projects designed at the Skull Base Institute. Some of the projects described previously have gone on to publication and others are awaiting final approval.

The model currently uses a transcer-vical approach for hypophysectomy and a transauricular approach for tranpslantation of the human fetal pituitary cells.

Dr. Shahinian’s extensive experience with children suffering from a variety of congenital malformations has led to a paper which has been published in the American Journal of Perinatology. The paper describes his experience with children who have required reconstructive surgery for lambdoid synostosis. Analysis of our patient population revealed several significant findings which had not been previously described. Lambdoid synostosis was noted in our patients to be associated with a significantly prolonged first stage of labor. These findings may lead to an earlier diagnosis and earlier attempts at non-operative treatment.

There has been progress in the two basic science projects with which the Skull Base Institute is primarily involved. We had previously described research into panhypopituitarism and a possible treatment with pituitary cell transplantation. Previous work in animal models had hinted that animal neonatal grafts were better tolerated than adult grafts. Furthermore, immunosuppression with cyclosporine enhanced the survival of these grafts. Based on these findings, we have transplanted human fetal pituitary cells into an animal model. The initial results have been promising but perplexing. These results have encouraged us to continue with several modifications. The model currently uses a transcervical approach for hypophysectomy and a transauricular approach for tranpslantation of the human fetal pituitary cells. Complete results are expected shortly and promise to be exciting to research of fetal tissue as well as transplantation of the pituitary gland.

The continuing advances in endoscopy will continue to expand our ability to treat and cure patients who only a short time ago would have been diagnosed as inoperable.

A new project is also progressing rapidly regarding the pituitary gland. Within the last decade, surgery of the skull base has been revolutionized by advancements in technology. Procedures which used to require a minimum of three teams of surgeons now can be performed by one surgeon with more specific experience in skull base disorders. Operations on the pituitary gland and the sella turcica have benefited from these advancements. In order to continue to minimize incisions, pain and disability, the Institute has initiated a long term plan which will safely introduce the use of ultrathin endoscopes for these operations. Animal models are being used to test effi-cacy and safety in extensive and complicated procedures. Once the technique and tools have been proven to be safe, we will proceed to introduce these advances to our patients. The continuing advances in endoscopy will continue to expand our ability to treat and cure patients who only a short time ago would have been diagnosed as inoperable.

Several other projects have been awaiting approval for publication. We have submitted two descrip-tions of interesting patients. One patient was an isolated metastasis to the skull base after papillary carcinoma of the thyroid gland. Metastases to the brain occur in 1% of patients with papillary carcinoma of the thyroid gland. This particular pre-sentation is anecdotal. This patient became symptomatic and work up revealed an isolated metastasis which was successfully resected. Follow up CT scans revealed complete resection. We have sub.mitted this report to the Journal of Clinical Endocrinology and Metabolism.

Additionally, we have submitted a description of a technique used at the Skull Base Institute for access to the infratemporal fossa. We have successfully and safely used a combined approach using modifications of traditional procedures to safely expose large tumors while sparing hearing. This is an important advancement in surgical technique in that it decreases the morbidity for our elderly patients.

Finally, these projects and many other ongoing experiments will be continued by a new fellow as of July. We are excited to welcome Dr. Reza Jarrahy from New York University who will join the Skull Base Institute for two years.