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Minimally Invasive Approaches to the Management to Neurosurgical Diseases

In this issue of Neurosurgery News, Several specialists join together to discuss topics that included new hope for life after stroke, leading the way in minimaly invasive management of neurosurgical Diseases, thirty years of brain gamma knife radiosurgery at UPMC, institutional outcomes research with endoscopic endonasal approaches for skull base chordoma, upmc trial of neoadjuvant radiosurgery offers a novel treatment option for metastatic brain tumors, and EEA for odontoidectomy.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Improve patient outcomes by implementing the use of a new surgical tool designed to better manage intracranial hemorrhage.
  • Improve the management of intracranial hemorrhage by understanding the limitations of past trials
  • Learn the common and current uses of radiosurgery and review the history of Gamma Knife radiosurgery at UPMC
  • Describe the gross total resection rates for chordomas
  • Describe the importance of the degree of resection for progression free survival
  • Follow recommended protocols regarding the necessity of radiation therapy and/or Radiosurgery in the treatment of brain metastasis
  • Recognize the challenges of adjuvant radiosurgery after resection of a brain metastasis.
  • Explain neo-adjuvant therapy within clinical practice and cancer care.
  • Recognize potential complications of transoral odontoidectomy, including the benefits of endoscopic endonasal resection of the odontoid.
  • Review the largest series of endoscopic endonasal odontoidectomy, and recognize the potential complications and benefits of the endoscopic endonasal approach for odontoidectomy.

Reading Resources:

  1. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM; STICH II Investigators..Lancet. 2013 Aug 3;382(9890):397-408.
  2. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH; STICH investigators.Lancet. 2005 Jan 29-Feb 4;365(9457):387-97.
  3. Hanley DF, Thompson RE, Muschelli J, Rosenblum M, McBee N, Lane K, Bistran-Hall AJ, Mayo SW, Keyl P, Gandhi D, Morgan TC, Ullman N, Mould WA, Carhuapoma JR, Kase C, Ziai W, Thompson CB, Yenokyan G, Huang E, Broaddus WC, Graham RS, Aldrich EF, Dodd R, Wijman C, Caron JL, Huang J, Camarata P, Mendelow AD, Gregson B, Janis S, Vespa P, Martin N, Awad I, Zuccarello M; MISTIE Investigators. Lancet Neurol. 2016 Nov;15(12):1228-1237
  4. Monaco EA, Grandhi R, Niranjan A, Lunsford LD. The past, present and future of Gamma Knife radiosurgery for brain tumors: the Pittsburgh experience. Expert Rev Neurother 2012;12:437-45.
  5. Niranjan A, Lunsford LD. Gamma Knife Radiosurgery for 5 to 10 Brain Metastases: A Good Option for Upfront Treatment. Oncology 2016;30.
  6. Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. Journal of neurosurgery 2005;102 Suppl:195-9.
  7. Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Mendenhall WM, Suárez C, Rinaldo A, Ferlito A. Clival chordomas: A pathological, surgical, and radiotherapeutic review. Head Neck. 2014 Jun;36(6):892-906. doi: 10.1002/hed.23415. Epub 2013 Oct 4. Review. PubMed PMID: 23804541.
  8. Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH. Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery. 2012 Sep;71(3):614-24; discussion 624-5. doi: 10.1227/NEU.0b013e31825ea3e0. PubMed PMID: 22592328.
  9. Koutourousiou M, Snyderman CH, Fernandez-Miranda J, Gardner PA. Skull base chordomas. Otolaryngol Clin North Am. 2011 Oct;44(5):1155-71. doi: 10.1016/j.otc.2011.06.002. Epub 2011 Jul 21. Review. PubMed PMID: 21978899.
  10. Rao G, Ahmed S, Hess K, Mahajan A. Postoperative stereotactic radiosurgery vs. observation for completely resected brain metastases: results of a prospective randomized study. Neurosurgery 2016 Aug;63 Suppl 1:184.
  11. Luther N, Kondziolka D, Kano H, et al. Predicting tumor control after resection bed radiosurgery of brain metastases. Neurosurgery 2013 Dec;73(6):1001-1006.
  12. Patel KR, Burri SH, Boselli D, et al. Comparing pre-operative stereotactic radiosurgery (SRS) to post-operative whole brain radiation therapy (WBRT) for resectable brain metastases: a multi-institutional analysis. J Neurooncol 2017 Feb;131(3):611-618.
  13. Zwagerman NT, Tormenti MJ, Tempel ZJ, Wang EW, Snyderman CH, Fernandez-Miranda JC, Gardner PA. Endoscopic endonasal resection of the odontoid process: clinical outcomes in 34 adults. J Neurosurg. 2017 May 12:1-9. doi: 10.3171/2016.11.JNS16637.
  14. Tubbs RS, Demerdash A, Rizk E, Chapman JR, Oskouian RJ. Complications of transoral and transnasal odontoidectomy: a comprehensive review. Childs Nerv Syst. 2016 Jan;32(1):55-9. doi: 10.1007/s00381-015-2864-6. Epub 2015 Aug 7. Review
  15. Re M, Iacoangeli M, Di Somma L, Alvaro L, Nasi D, Magliulo G, Gioacchini FM, Fradeani D, Scerrati M. Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. Acta Otorhinolaryngol Ital. 2016 Apr;36(2):107-18. doi: 10.14639/0392-100X-647. Epub 2016 Apr 29.

Disclosures:

Drs. Jankowitz, Niranjan, Zenonos, Gardner, Engh, Zwagerman, and Fernandez-Miranda have reported no relevant relationships with proprietary entities producing health care goods or services.

Dr. L. Dade Lunsford has financial interests with the following proprietary entity or entities producing health care goods or services as indicated below:

  • Consultant: Insightec, DSMB
  • Stockholder: Eleckta

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.com and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 8/22/2017 | Last Modified On: 8/22/2017 | Expires: 8/22/2018

Additional Resources

Presenters

Brian Jankowitz, MD

Brian Jankowitz, MD Assistant Professor of Neurological Surgery
Co-Director, Endovascular Therapy
Director, Neuroendovascular Fellowship Program
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Ajay Niranjan, MD, MBA

Ajay Niranjan, MD, MBA Associate Professor of Neurological Surgery
Director, UPMC-Brain Mapping Center (MEG)
Associate Director, Center for Image-Guided Neurosurgery
Director, Radiosurgery Research
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L. Dade Lunsford, MD

L. Dade Lunsford, MD L. Dade Lunsford, MD is the Lars Leksell Professor and Distinguished Professor at the Department of Neurological Surgery at the University of Pittsburgh. He also is director of the Center for Image-Guided Neurosurgery at the University of Pittsburgh Medical Center and an internationally ...
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Georgios Zenonos, MD,

Georgios Zenonos, MD, Georgios A. Zenonos, MD, joined the Department of Neurological Surgery in July of 2011.
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Paul Gardner, MD

Paul Gardner, MD Associate Professor of Neurological Surgery
Neurosurgical Director, Center for Skull Base Surgery
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Johnathan Engh, MD

Johnathan Engh, MD University of Pittsburgh Physicians
Department of Neurological Surgery
Hillman Cancer Center
5150 Centre Ave.
2nd Floor
Pittsburgh, PA 15232
Office Phone: (412) 647-7614
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Nate Zwagerman, MD

Chief Resident
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Juan C. Fernandez-Miranda, MD

Juan C. Fernandez-Miranda, MD Associate Professor of Neurological Surgery
Associate Director, Center for Skull Base Surgery
Director, Surgical Neuroanatomy Lab
Director, Fiber Tractography Lab
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