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The Importance of a Multidisciplinary Team

Program: Skull Base Surgery
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Andrew Schorr:

And let's also welcome a colleague of yours, Dr. Franco DeMonte. He's also professor of surgery and medical director of the brain and spine center at M. D. Anderson. Dr. DeMonte, welcome to you. I know for both of you gentlemen it must do your heart good to hear a story like Gerald's. Dr. DeMonte, that multidisciplinary team and your experience with people coming from around the world with some of these relatively rare cancers, it must make you feel great that you can bring that collective experience together to do what's right for each individual.

Dr. DeMonte:

Oh, I think that's so true. I feel sorry for people who don't have the backup that we do, because it can be overwhelming when you pick up (book) chapters and look at this problem and just the lists of the possible pathologies, possible tumor varieties in those locations, no one person has that fund of knowledge. We have all kinds of pathologists. We have 50 people in a room with us discussing patient care, and the wealth of that experience is tremendous, and I feel extremely fortunate to have that kind of backing here at M. D. Anderson.

Andrew Schorr:

Dr. Hanna, help us understand. When we talk about skull base cancers, this is a really tricky area to have a cancer. So it seems like you need a whole team to understand what are you dealing with, very sophisticated diagnostic techniques and surgical techniques, radiation as well, to try to do what's right for each individual patient.

Dr. Hanna:

Absolutely. And you know skull base surgery compared to other specialties in medicine and particularly surgical specialties is relatively new. And as you can imagine from just the term "skull base," it is precisely what it is. It's the base of the skull. It's where the brain sits on top, and all these structures that travel from the brain into the head and neck area pass through the skull base. And the area, as Dr. DeMonte described, has a variety of tumors simply because some of them come from below the skull base and travel upwards, heading towards the brain. Like in Mr. Ahrens' case, it was a sinus tumor heading up. Some of those are brain tumors heading down. That's a little less common. And then there are some unique types of tumors that come from within the base itself, from within the bony structure that makes the base of the skull.

And the interesting thing is until recently this area was considered inaccessible. When people had skull base tumors they were told that there's no cure, there's no way to remove it. And the reason for that is head and neck surgeons like myself would go as far up as they can and they'd stop at the skull base because it was uncharted territory for them. And then neurosurgeons would head down, and again once they passed their traditional area of training which is inside the skull they feel a bit unfamiliar and a bit uncomfortable. And it took literally the decisive collaboration between specialties to break down the barriers to say, you know, this is an area where we can see an opportunity that if we work together we would open up a whole frontier for a whole host of patients.

And I honestly don't think that skull base surgery could be possible without a team of surgeons from different specialties and different disciplines working together in concert during the surgery, before the surgery, after the surgery, which is precisely why I think our multidisciplinary team functions so well. We embrace that concept of team work, and I'm fortunate to have someone like Dr. DeMonte that I work with very closely.

Andrew Schorr:

That's neat. So Dr. DeMonte, you're a neurosurgeon, right?

Dr. DeMonte:

Yes.

Andrew Schorr:

And, Dr. Hanna, you're a head and neck surgeon. So that's an example of the team. And then there's a whole group, a multidisciplinary group of people that work with you. So on the front side we've got the diagnostic folks, what are you dealing with and the imaging you can do. You have a variety of different surgical approaches, and we'll talk more about that. And then there's all the follow-up in helping people get rehabilitated so they can go back to a full life. And I know you have ophthalmologists, you have audiologists, you have swallowing experts, nutritionists. It sounds like, Dr. DeMonte, you have quite a worldclass team.

Dr. DeMonte:

It's a wonderful group. Really we want to maximize the outcome, and to do an operation, shake somebody's hand and say see you later doesn't do that. It just doesn't meet needs. It doesn't meet rehabilitative needs. It doesn't meet psychosocial needs. It doesn't meet quality of life needs. I think the group we have can address specific problems that may arise in the postoperative recovery phase that allows patients to maximize their quality of life and their functionality and their outcome. I think it's a very important aspect that's not talked a lot about, but it's vital to the optimizing the outcome of treatment.

Andrew Schorr:

Yeah, I certainly believe that. Dr. Hanna, I've got a question for you.

Dr. Hanna:

Yes.

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