Together Drs. Ferreira and Moe lead a team that has become one of a select few groups that perform highly complex surgeries using endoscopically, minimally disruptive techniques for the resection of skull base tumors.
Dr. Manuel Ferreira Jr. is the co-director of Skull Base and Minimally Invasive Neurosurgery at the University of Washington, Harborview Medical Center and Assistant Professor in the Department of Neurological Surgery. He specializes in the multi-modality treatment of skull base tumors. Dr. Kris Moe is chief of the Division of Facial Plastic and Reconstructive Surgery and Associate Professor in the Department of Otolaryngology – Head and Neck Surgery. Together Drs. Ferreira and Moe lead a team that has become one of a select few groups that perform highly complex surgeries using endoscopically, minimally disruptive techniques for the resection of skull base tumors.
Recently, Drs. Ferreira and Moe were presented with a patient that had a tumor between the pituitary gland and the optic chiasm.
The 29 year-old professional, mother of two, began losing her vision due to this tumor. In one week, her vision had deteriorated by 80%. An MRI scan showed a cystic and calcified tumor to be displacing her optic nerves, consistent with a craniopharyngioma. Traditionally, the procedure used to remove the tumor would consist of a highly invasive craniotomy, in which the surgeons would temporarily remove a bone flap from the skull to access the portion of the brain where the tumor is located. This type of tumor is very difficult to completely resect without destroying pituitary function, requiring life-long hormone replacement therapy for the patient. During a traditional craniotomy, visualization of the area of resection is highly difficult and a portion of the tumor resection is done blindly. Most patients lose most, if not all, pituitary function following the procedure which may also prevent patients from conceiving further children. Furthermore, after a craniotomy, a patient is usually hospitalized for 5-14 days and usually requires a 6-8 week recovery time.
Recognizing the potential impact on the patient’s quality of life, Drs. Ferreira and Moe opted instead for a relatively new, cutting edge minimally invasive endoscopic extended surgery performed through the nasal passage, this less invasive procedure provides the surgeon with additional visualization of the hypothalamic/pituitary stalk region (which cannot be seen directly via a craniotomy).
While performing a new procedure can be a challenge to even the most experienced of surgeons, Drs. Ferreira and Moe took the opportunity to visit the Institute for Simulation and Interprofessional Studies at HMC to first perform the operation on a cadaver. Two days prior to the surgery, the complete procedure was performed using the state-of-the-art facility, allowing these experienced surgeons to “rehearse” the exact procedure that they would later perform on the patient. Through this operative rehearsal, the surgeons knew exactly what approach to take, and exactly what to expect.
As a result, the surgeons were able to completely resect the tumor, leaving the patient’s pituitary function intact (no hormonal replacement necessary), and she regained normal vision in both eyes. She is back to work, and back to her normal lifestyle. Dr. Ferreira credits the success, confidence, cohesiveness, and time efficiency of this procedure to the ability to practice in the Institute at HMC.
Besides being the place for residents, students, and other healthcare professionals to train and practice skills, the Institute at HMC offers opportunities for experienced attending physicians to train on new technologies and practice specific skills prior to performing on patients. This is an example of how the Institute truly impacts patient care in quality and safety.
“The Institute lab at HMC is an invaluable resource to surgical subspecialists here at the University of Washington. It aids in the training of resident, fellow and attending physicians, ultimately having a positive impact on our patients.”