Pituitary & Skull Base Surgery Program
The Skull Base and Pituitary Tumor Program of Pickup Family Neurosciences
Institute aligns neurosurgeons, otolaryngologists, neurologists, neuro-opthalmologists,
neuroradiologists and endocrinologists around the care of patients with
pituitary tumors and other neoplasms of the intricate skull base region.
The latter includes meningiomas, craniopharyngiomas, schwannomas, epidermoid
tumors, and other invasive tumors that affect this portion of the anatomy.
The program focuses on combining the latest advanced and emerging technology
with minimally invasive techniques in order to offer the best possible
outcomes to patients with these rare and complex tumors. The majority
of these surgeries are done through tiny incisions or using naturally
occurring orifices such as the nostrils.
Since 2014, the Skull Base and Pituitary Tumor Program has seen dramatic
growth under the program direction of Robert Louis, M.D. In the years
since the program’s inception, a total of 301 minimally invasive
surgeries for tumor removal have been completed at Pickup Family Neurosciences
Institute.
This rapid growth in case volume speaks to the obvious demand for this
subspecialty of neurosurgery in Orange County, and the trust that patients
with these tumors have placed in our hands. While case volumes by themselves
are a great measure of growth, what counts is the effect on patient outcomes.
Numerous studies have demonstrated that surgeons and centers with more
experience and which perform higher numbers of these complex cases have
higher success rates and lower rates of complications. Indeed, a significant
minority of the cases treated in our program are repeat surgeries for
inadequate treatment from other facilities. As a result, Pickup Family
Neurosciences Institute at Hoag is establishing itself as the only Center
of Excellence for Pituitary Surgery in Orange County. The four years of
surgical outcome data, including remission and complication rates, are
meeting or exceeding nationally established standards for pituitary surgery.
Technological Advances – Precision Neurosurgery
Since 2015, minimally invasive neurosurgery has been guided using the Surgical
Navigation Advanced Platform (SNAP), by Surgical Theater. This giant leap
forward for planning and performing brain surgery is a system developed
and based on flight simulator technology for F-16 fighter jets. It allows
for Virtual Reality 360-degree reconstruction, planning, rehearsal and
navigation for complex neurosurgical procedures. By performing a Virtual
Reality “fly-through” on each case, our surgeons are literally
able to practice an operation in 3-D before ever picking up the scalpel.
The tool optimizes minimally invasive approaches, with smaller incisions,
fewer complications, and better overall outcomes. In the three years since
Surgical Theater was introduced, more than 1,200 neurosurgical surgical
cases have been performed at Pickup Family Neurosciences institute using
this innovative technology.
Building upon the same platform, in 2017, EndoSNAP was introduced at Hoag.
This provides the additional capabilities of Augmented Reality for endoscopic
cases. The split screen view provided by the EndoSNAP gives the surgeon
a “heads-up display” and allows for pinpoint accuracy and
improved visualization of critical structures. Dr. Louis has been at the
forefront of the development and implantation of virtual reality and augmented
reality guidance for neurosurgery and beyond. Hoag’s Pickup Family
Neurosciences Institute remains the only center in California and ranks
as the second highest volume center in the nation to use Augmented Reality
in Neurosurgery.
The Skull Base and Pituitary Tumor Program’s technology enhanced
clinical practice approach via implementation of a cutting-edge VR visualization
platform was validated as shown by the following success measures:
- Infection/Meningitis – 0.7%
- Post-op CSF leak – 1.2%
- Diabetes Insipidus – transient 36%, permanent 5%
Mass of the Pituitary gland due to auto-immune Granulomatous Hypophysitis
Team
The Pituitary Program is led by Robert Louis, M.D., Board Certified Neurosurgeon
and an expert in endoscopic and minimally invasive treatment of benign
and malignant brain tumors, sellar, parasellar and skull base tumors.
Dr. Louis’ unique background includes two fellowships in Complex
Cranial Surgery and Minimally Invasive Skull Base and Pituitary Surgery.
Timothy Kelley, M.D., is the ENT surgeon and partners with Dr. Louis for
many of these complex cases. His particular expertise lies in endoscopic
sinus and skull base surgery.
Chris Duma, M.D., is the director of the Hoag Brain Tumor Program and also
serves a pivotal role in the Skull Base and Pituitary Program. Drs. Louis,
Duma, and Kelley often work together, combining their skills and expertise
to ensure the best possible outcome for patients.
The multidisciplinary team also includes endocrinologists, neuro-radiologists,
ophthalmologists, neurologists, pathologists and neuro-oncologists.
The nurse navigator for the program is Lori Berberet, R.N., who helps coordinate
the complex and often confusing journey from diagnosis to cure.
Surgical Outcomes
Composed of pituitary adenoma, craniopharyngioma, Rathke’s Cleft
Cysts, meningioma, schwannoma, metastases, epidermoid, dermoid, hemangioma,
hemangioblastoma, SNUC, Olfactory Neuroblastoma.
Lectures at National/International Conferences
Using Virtual Reality Technology across the Patient Treatment Continuum
Results in Enhanced Patient Engagement and Satisfaction. HIMSS Physicians’
Executive Symposium. March 5, 2018. Las Vegas, NV.
Augmented Reality in Neuro-endoscopy Enhances Visualization of Critical
Structures. Society for Brain Mapping and Therapeutics. April 15, 2018.
Los Angeles, CA.
Using Virtual Reality Technology across the Patient Treatment Continuum
Results in Enhanced Patient Engagement and Satisfaction. Becker’s
Hospital Review 4th Annual Health IT + Revenue Cycle Conference. September
20, 2018. Chicago, IL.
Virtual Reality and Augmented Reality in Neurosurgery. Congress of Neurological
Surgeons Annual Meeting. October 23, 2018. Houston Texas.
Extended Reality Technology Throughout the Patient Care Continuum. Mount
Sinai School of Medicine - Digital Neurosurgery Symposium. December 7,
2018. New York, NY.
From Microchips to Microsurgery, Extending Lives with Extended Reality
Technology. Intel Global Manufacturing Conference. December 13, 2018.
Anaheim, CA.
Publications, Book Chapters Invited Lectures
Editor, Central and Peripheral Nervous System. Netter Atlas of Anatomy.
Published 2018
Louis RG Jr, Whitesides JD, Kollias TF, Iwanaga J, Tubbs RS, Loukas M.
Intercostal Nerve to Long Thoracic Nerve Transfer for the Treatment of
Winged Scapula: A Cadaveric Feasibility Study. Cureus. 2017 Nov 30;9(11):e1898.
doi: 10.7759/ cureus.1898. PubMed PMID: 29399426; PubMed Central PMCID:
PMC5790210.
Barkhoudarian G, Farahmand D, Louis RG, Oksuz E, Sale D, Villanueva P,
Kelly DF. Microsurgical Endoscope-Assisted Gravity-Aided Transfalcine
Approach for Contralateral Metastatic Deep Medial Cortical Tumors. Oper
Neurosurg (Hagerstown). 2017 Dec 1;13(6):724-731. doi: 10.1093/ons/opx067.
PubMed PMID: 29186601.
Loukas M, Du Plessis M, Louis RG Jr, Tubbs RS, Wartmann CT, Apaydin N.
The subdiaphragmatic part of the phrenic nerve - morphometry and connections
to autonomic ganglia. Clin Anat. 2016 Jan;29(1):120-8. doi: 10.1002/ca.22652.
Epub 2015 Oct 30. PubMed PMID: 26457392.
Oldfield EH, Vance ML, Louis RG, Pledger CL, Jane JA Jr, Lopes MB. Crooke’s
Changes In Cushing’s Syndrome Depends on Degree of Hypercortisolism
and Individual Susceptibility. JClin Endocrinol Metab. 2015 Aug;100(8):3165-71.
doi: 10.1210/ JC.2015-2493. Epub 2015 Jul 6. PubMed PMID: 26147609.
Louis RG, Eisenberg A, Barkhoudarian G, Griffiths C, Kelly DF. Evolution
of minimally invasive approaches to the sella and parasellar region. Int
Arch Otorhinolaryngol. 2014 Oct;18(Suppl 2):S136-48. doi: 10.1055/s-0034-1395265.
Review. PubMed PMID: 25992138; PubMed Central PMCID: PMC4399582.
Loukas M, Shane Tubbs R, Louis RG Jr, Apaydin N, Bartczak A, Vefali H,
Alsaiegh N, Fudalej M. Erratum to: An endoscopic and anatomical approach
to the septal papillary muscle of the conus. Surg Radiol Anat. 2015 Jul;37(5):569.
doi: 10.1007/ s00276-015-1422-y. PubMed PMID: 25601580.
Dallapiazza R, Bond AE, Grober Y, Louis RG, Payne SC, Oldfield EH, Jane
JA Jr. Retrospective analysis of a concurrent series of microscopic versus
endoscopic transsphenoidal surgeries for Knosp Grades 0-2 nonfunctioning
pituitary macroadenomas at a single institution. J Neurosurg. 2014 Sep;121(3):511-7.
doi: 10.3171/2014.6.JNS131321. Epub 2014 Jul 4. PubMed PMID: 24995783.