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Steps in Developing a Treatment Plan

Program: Skull Base Surgery
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Andrew Schorr:

Welcome back to Patient Power as we continue our discussion of the latest approaches for skull base tumors and skull base surgery and allied treatments that come together with two leading experts from M. D. Anderson, Dr. Ehab Hanna and Dr. Franco DeMonte, and also a patient who says these gentlemen and the whole team saved his life, and that's Gerald Ahrens, a pilot from Conroe, Texas.

Dr. DeMonte, help us understand. You as a neurosurgeon and your colleagues in head and neck surgery and the other team members, what's available to you as you learn more about somebody's tumor within their skull? What are some of the different things that come into play? What's the state of the art now, if you will?

Dr. DeMonte:

As Dr. Hanna mentioned in the earlier segment, it starts when the patient walks through the door in obtaining the highest quality diagnostic imaging. Because that does two things for us. It sometimes gives us clues to the nature of the tumor, but it also gives us detailed anatomic information which is going to be really critical in constructing the appropriate approach to the tumor. Sometimes these approaches require the movement of the orbit out of the way temporarily. Sometimes it requires movement of the posterior part of the skull or ear area out of the way in order to get to these tumors. So that has to be planned very carefully initially.

And that imaging that's done is able to be imported into the operating room during the time of the patient's surgery such that the planning that we have gone through prior to surgery is imported, is able to be transferred to the real time situation of the operation and allows us three dimensional visualization of both our planning and its application at the time of the operation.

Andrew Schorr:

I've talked to some of your colleagues there, and I was trying to visualize this in my head. So first you have sort of a GPS of where you are and what you're doing, but as you excise tumor things are also moving around, so you kind of need that real time imaging because your road map is changing, right?

Dr. DeMonte:

That's very, very important in the brain, which is a more a viscoelastic, more of a moveable tissue. A benefit we have in the base of skull is that most of these tumors are locked into the bony skull base, so that bone is a fixed anatomic point. So we don't have the same problems that occur in the brain where as you remove tumor the brain and the tumor moves. So I think with skull base surgery we have the luxury of not necessarily requiring real time intraoperative imaging for most of these tumors. Some do require that, and fortunately we do have the technology to do real time intraoperative MRI imaging, and we definitely utilize that technology in those cases where it is necessary.

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