Brain Tumor and Neuro-Oncology Center - Cleveland Clinic

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Clinical Programs (continued)
In 2007, further expertise in endoscopic surgery for
skull base indications was provided with the addition
of Dr. Burak Sade to the Skull Base Surgery Program.
BTNC endoscopic neurosurgeons work closely with
endoscopic sinus surgeons in Cleveland Clinic’s Head
and Neck Institute to provide minimally invasive surgical
management for skull base malignancies, in addition to
pituitary region tumors.
Pituitary and Neuro-Endocrine Center (PNEC)
The Neuro-Endocrine Center has shown continuous
growth since its inception in 2002, fostered by a
close working relationship among members of the
BTNC and the departments of Endocrinology, Diabetes
and Metabolism; Neurological Surgery; Neuro-
Ophthalmology; and Radiation Oncology. The close
relationship has led to the development of highly
integrated clinical care pathways, a common pituitary
tumor research database and several joint research
projects (see below).
Clinical Care Pathways
Clinical care pathways define the pre-hospital,
perioperative and postoperative care for patients with
secretory and non-secretory pituitary tumors. The
development of new pathways has helped decrease
patient length of stay, with equal patient outcomes.
Academic Activities
A prospective IRB-approved database has been
established for all patients with pituitary tumors seen
in the Neuro-Endocrine Center. Detailed preoperative
endocrine testing, including Cortrosyn stimulation, is
routinely performed for comparison to postoperative
findings. New clinical care pathways have eliminated
the routine use of perioperative steroids, thereby
enabling the accurate determination of postoperative
pituitary adrenal activity. Several retrospective analyses
have been completed and are also in progress,
including comparison of Gamma Knife vs. IMRT for
BRAIN TUMOR AND NEURO-ONCOLOGY CENTER
subtotally resected somatotrophic pituitary adenomas,
case review of pituicytoma, an analysis of the impact
of somatostatin on the efficacy of radiosurgery for
somatotrophic adenoma, and an evaluation of the role
of radiosurgery and postoperative pituitary insufficiency.
Additional collaborative work with groups outside
Cleveland Clinic has focused on what role mutations in
the aryl hydrocarbon receptor interacting protein gene
(AIP) may play in the formation of pituitary tumors,
especially familial acromegaly (excess growth hormone
secretion due to a pituitary tumor) or in the early onset
of these tumors in the sporadic setting. This resulted
in two publications in 2007-2008: Georgitisi et al,
Proceedings of the National Academy of Sciences
USA (PNAS), 104(10): 4101-5, 2007 and Clinical
Endocrinology, 2008, in press.
Teaching of residents and fellows has similarly
been augmented through the establishment of the
center. Endocrine residents routinely participate
in outpatient evaluation with endocrinologists and
surgeons. BTNC fellows are intimately involved in
the outpatient, operative and inpatient care of all
patients. Neurosurgery residents play a critical role in
the inpatient and surgical care of these patients, and
are frequently able to attend outpatient clinics. A joint
conference involving endocrinology, neurosurgery, neuroophthalmology,
neuroradiology and radiation oncology
is held on the first Friday of each month, during which
case presentations and management or visiting lecturers
are presented.
In addition, monthly pathology review sessions, where
the pathological findings of each patient are reviewed
jointly by the pathologists, endocrinologists and
neurosurgeons (the Pituitary Interest Group), continue.
These sessions are open to all interested parties and
are held the first Monday of the month in the Pathology
& Laboratory Medicine Institute. A dedicated Advanced
Neurosurgical and Spine Skills and Simulation
Laboratory (ANSSSL) has also been developed
through the Pituitary and Neuro-Endocrine Center’s