Pituitary Tumor Surgery

In addition to ground-breaking work in developing TONES (transorbital neuroendoscopic surgery), Kris S. Moe, M.D. ’89, Res. ’91, ’94, UW associate professor in the Department of Otolaryngology-Head and Neck Surgery and chief of the Division of Facial Plastic and Reconstructive Surgery, and his colleagues also have broken new ground in the realm of endoscopic pituitary surgery — another subset of minimally invasive brain surgery.

The UW Medicine Neurosciences Institute’s pituitary program clinic, with surgical leader Manuel Ferreira, M.D., Ph.D., Fel. ’10, UW assistant professor in the Department of Neurological Surgery and co-director of Skull-base and Minimally Invasive Neurosurgery at Harborview Medical Center, provides comprehensive care with a multi-disciplinary team of specialists — including neurosurgeons, endocrinologists, neuro-ophthalmologists, radiologists, pathologists, otolaryngologists, radiation oncologists, nurses and patient-care coordinators — trained to treat complex pituitary tumors.

“The program allows us to consolidate all our pituitary tumor surgeries at Harborview, which leads to better outcomes,” explains Anthony M. Avellino, M.D., Res. ’00, FACS, MBA, director of the UW Medicine Neurosciences Institute. The location of a specialized clinic within Harborview means that patients can have “one-stop” appointments for evaluation and treatment of both emergent and acute-care needs, as well as access to leading-edge technologies. The system is also more cost-efficient.

In fact, in June, 2010, Harborview upgraded to the Gamma Knife Perfexion radiosurgery system — a state-of-the-art technology for highly precise radiation therapy. The Perfexion system allows treatment of a wide range of targets faster and more efficiently than ever before. The clinic also provides a combination of intraoperative CT scans and preoperative MRI during surgical procedures, enabling better localization of the tumor anatomy and improved patient outcomes.

“The endoscopic procedures UW Medicine pituitary specialists perform are safer, less painful, cause less tissue damage and have a shorter recovery time than traditional surgeries,” says Avellino.


Kris Moe and his colleagues lead the field in endoscopic pituitary surgery.

BUILDING A BETTER, ROBOTIC ENDOSCOPE

For transorbital neuroendoscopic surgery or TONES to address pathologies deeper in the brain, endoscopic technologies must evolve.

“Our ability to reach deep areas of the orbit and brain exceeds our ability to operate endoscopically in these regions,” says Kris S. Moe, M.D. ’89, Res. ’91, ’94, UW associate professor in the Department of Otolaryngology-Head and Neck Surgery and chief of the Division of Facial Plastic and Reconstructive Surgery.

To overcome this hurdle, Moe and an interdisciplinary team of researchers are working to develop a new surgical system for TONES: robotic, flexible endoscopes capable of seeing around corners and operating on targets deep within the brain, where today’s angled, rigid endoscopes cannot go.

In addition to Moe, the research group includes two neurosurgeons, Laligam N. Sekhar, M.D., FACS, and Louis J. Kim, M.D., and a pediatric urologist, Thomas S. Lendvay, M.D., from UW Medicine, and two robotics engineers, Blake Hannaford, Ph.D., at the University of Washington, and Jacob Rosen, Ph.D., at the University of California at Santa Cruz. Professors Hannaford and Rosen designed the RAVEN robot, the major surgical robotic research platform at a number of leading universities in the U.S.

With funding from the U.S. Department of Defense, the team has developed a prototype flexible endoscopic surgery system and is completing the final prototype of a robotic console. The process will include image-guided surgical planning, in which the computer offers several different options to the surgeon, and computer-assisted navigation of the endoscope into the surgical field.

“[The system] will allow us to perform surgery on areas that were previously difficult or impossible to reach,” Moe explains. It also will minimize what Moe calls pathway trauma (collateral damage) from surgery. “We have the potential to take the pathway trauma to near zero by using very fine, flexible endoscopes. Then the way to further minimize trauma is to use robotic surgery,” he says.