endonasal

Helpful Doctors: Dr. Fernandez-Miranda

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This month the spotlight focuses on Dr. Juan Carlos Fernandez-Miranda, a Professor of Neurosurgery and the Surgical Director of Brain Tumor, Skull Base and Pituitary Centers at Stanford University. Dr. Fernandez-Miranda did a neurosurgery residency at La Paz University Hospital in Madrid, Spain. He completed a fellowship in microsurgical neuroanatomy at the University of Florida. He did clinical training in cerebrovascular surgery at the University of Virginia, and in endoscopic endonasal and open skull base surgery at University of Pittsburgh Medical Center (UPMC). He joined the faculty at Stanford earlier this year. He was kind enough to answer some questions from the PNA. His answers are below:

What inspired you to choose your career path?

When I was a young kid, about 10-11 years old, I got sick with a skin rash and high fever; the family doctor visited our home, carefully examined me, and based on a number of clues, he determined I got a very rare bacterial infection known as scarlet fever; a few days of antibiotic medication and I was back to normal. I now realized that I was fascinated by the wisdom, expertise, and detective attitude of the physician, and this personal event was (I now know) key to my future decision to become a doctor.

As I started medical school, I became deeply interested in the structure of the brain and how it explains brain and perhaps even mind function. I realized that the closest I could get to know the brain was actually as a surgeon operating on it.

I became a neurosurgery resident, and I immediately felt that entering into a patient’s brain, skull base, or pituitary gland was a huge privilege and a unique experience that will require my entire devotion and attention. I learned from my mentors the importance of precise knowledge of surgical neuroanatomy to perform gentle, accurate, and safe surgery. After residency training, I decided to spend 2 entire years in the lab – fully dedicated to mastering the understanding of the complex tridimensional surgical neuroanatomy required to safely and efficiently navigate the brain and skull base. These years, under the guidance of legendary neurosurgeon Albert Rhoton, served as the basis of everything I have accomplished thus far.

I was then fortunate to continue my clinical training at University of Virginia with several giants of neurosurgery, and I was greatly influenced by the meticulous approach of Dr. Ed Oldfield’s pituitary surgeries, particularly for Cushing’s disease. It was such a joy to watch his precise extracapsular tumor resections. At the same time, I had become totally enchanted by the endoscopic endonasal operations that Dr. Amin Kassam was performing at University of Pittsburgh, and after many requests he finally accepted me for specialized training with him and his team. That was a life changing event for me, as my career was about to be centered in the development and refinement of endoscopic endonasal skull base and pituitary surgery.

What is the primary focus of your work/research?

My primary clinical focus is the treatment of patients with pituitary, skull base, and brain tumors. I have particular technical expertise in endoscopic endonasal surgery for pituitary tumors and other skull base lesions, such as craniopharyngiomas, meningiomas, and chordomas, with an accumulated surgical experience of more than 1,000 cases. My clinical practice includes a full range of minimally invasive approaches, in addition to complex open skull base and brain surgery.

My research interests lie in the study of surgical neuroanatomy and the application of innovative techniques into the operating room that aim to improve surgical safety and effectiveness. As an example, along with my fellows, we have recently provided a new compartmental classification of the cavernous sinus that may help improve resection rates of pituitary tumors that invade the cavernous sinus, while preserving cranial nerve function. We have also described the structure of the medial wall of the cavernous sinus and the ligaments that anchor it to the carotid artery, and we have implemented an innovative surgical technique to selectively remove the medial wall of the cavernous sinus; this is extraordinarily important to achieve complete remission in certain functional tumors causing Cushing’s disease or acromegaly, and our results have proven not only the efficacy of this novel technique, but its safety when appropriately performed.

What do you consider to be the future of your field?

There is no doubt that the field is already moving towards multidisciplinary super-specialization, promoting the creation of Pituitary Centers of Excellence that provide dedicated clinical care, research, and education. This favorable trend will facilitate the development of more effective surgical and medical treatments. Pituitary tumors should only be treated by fellowship-trained neurosurgeons in this field at high-volume surgical centers.

In spite of the multiple advances in the treatment of pituitary tumors, we are still in need of further improvement at all levels. From the surgical point of view, the future is on developing better visualization tools and mini-robotic instruments that will allow more effective and less invasive operations. From the imaging point of view, I believe functional imaging, such as PET-MRI, may improve the diagnosis and localization of hormonally active microadenomas with “negative” MRI studies. The future will hopefully bring newer and more effective medical therapies for active and even inactive pituitary tumors.

What should patients know about your field/what deserves more recognition/awareness?

I think the most important message for current and future patients is to make sure they seek the best team around to treat their disease. It is important to emphasize the team approach, because experience, knowledge, and collaboration is critical to obtaining the best outcome. This extends to all members of the team, including not only the neurosurgeon and the endocrinologist, but also ENT, neuro-ophthalmologist, radiation therapist, neuroradiologist, and neuropathologist.

What would you like to convey about yourself to your patients?

I strive to offer my patients the best possible treatment, that combines ultimate surgical and technological applications with compassionate care. I believe in teamwork and I am privileged to work with such a stellar team at Stanford. I have dedicated my life to becoming the best possible surgeon for my patients.

Why did you get involved with the PNA and what is the extent of your involvement?

I have always been fascinated by the diagnosis and treatment of pituitary tumors and pituitary diseases, and I feel extremely fortunate to dedicate a large portion of my practice to helping pituitary patients. My motivations perfectly align with the PNA goals, and this is the main reason I got involved. I have contributed to the education and counseling of patients through the PNA and I hope to continue to do so for the years to come.

Adapted from https://pituitary.org/highlights-enewsletter-child/spotlight-dr-fernandez-miranda/

💉 Helpful Doctors: California

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Dr. Daniel Kelly, a board certified neurosurgeon, is Director of the Pacific Neuroscience Institute and Professor of Neurosurgery at the John Wayne Cancer Institute.

Considered to be one of the best neurosurgeons in the US and a multiple recipient of the Patients’ Choice Award, Dr. Kelly is internationally recognized in the field of minimally invasive keyhole surgery for brain, pituitary and skull base tumors.

He has one of the world’s largest series in endonasal surgery with over 2000 procedures performed including over 800 endonasal endoscopic surgeries, and over 2000 craniotomies for brain and skull base tumors. His current surgical practice encompasses the full spectrum of brain and skull base tumors, both benign and malignant, treated with minimally invasive and conventional approaches.

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💉 Helpful Neurosurgeon: Pennsylvania

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Lehigh Valley, Pa.,
March 03, 2021

Walter Jean, MD, has joined Lehigh Valley Health Network (LVHN) and will serve as Chief of Neurosurgery.

Jean is a board-certified neurosurgeon with expertise in complex intracranial surgery. He is known world-wide for his expertise in complex brain surgery. With nearly 20 years’ experience in both open and endoscopic skull base surgery, Jean has several clinical interests including acoustic neuromas, pituitary adenomas, skull base meningioma, intraventricular tumors, and trigeminal neuralgia. His acclaimed textbook, “Skull Base Surgery: Strategies,” is used by neurosurgeons across the globe to learn about open and endoscopic skull base surgery.

“I’m excited to join LVHN and continue to build on their solid foundation,” Jean says. “I hope to take LVHN Neurosurgery to the next level with robust clinical activity, research and innovation as well as education.”

As a pioneer, Jean utilizes virtual reality in neurosurgery.

“Virtual reality allows everyday people to fly to new lands in video games, augmented reality takes fighter pilots through scenarios training them for the unexpected,” Jean says. “Now brain surgeons and patients can also use these technologies to fly through the brain.”

Why is this so important? Jean says for those who find themselves in need of complex brain surgery, not only can they better visualize their upcoming procedure, their surgeon also gains additional insight. Jean is the only physician in the area using this groundbreaking technology.

“We meet hundreds of patients and explain to them our surgical plan,” Jean says. “That communication can be difficult at times. Once we have a patient’s brain scans loaded into the augmented reality software, they have the ability to see their own anatomy to gain a better understanding. When patients place the headset over their eyes, they are transported to a virtual replica of their own brain.”

The experience offers a visual explanation which is often easier to understand than medical terminology.

Another benefit of this leading-edge technology is that it allows brain surgeons create a surgery plan by simulating different scenarios to find the best approach. “The genesis of the technology is from air fighter pilots. The founders of the company discovered they could use the same technology in the medical field,” Jean says. “Just like fighter pilots, brain surgeons are able to practice unique scenarios to be fully prepared for their mission.”

Jean comes to LVHN from George Washington University Hospital, where he was a professor of neurological surgery. A native of Hong Kong, Jean attended Princeton University, where he graduated summa cum laude, and Cornell University Medical College, where he graduated at the top of his class and was elected Alpha Omega Alpha, a medical honor society. He completed neurosurgical training at the University of Minnesota, and fellowship in Skull Base Surgery at the University of Cincinnati.

Jean’s academic credentials includes being Program Director at Georgetown University for 7 years. He has authored numerous scholarly publications and has an international reputation as an energetic lecturer and passionate teacher of neurosurgery. Jean serves as reviewer for many high-impact journals such as the Journal of Neuro-Oncology, World Neurosurgery, Operative Neurosurgery, and Journal of Neurological Surgery, Part B. He is an active member of the American Association of Neurological Surgeons, Congress of Neurological Surgeons and the North American Skull Base Society and serves frequently as faculty at their national meetings.

📞 Webinar: Expect more from pituitary surgery: difference-makers for post-operative outcomes

MaryO Interviews, Meetings and Conferences , , ,

 Presented by

Ahmad Sedaghat, MD, PhD – Associate Professor and Director of the Division of Rhinology, Allergy and Anterior Skull Base Surgery in the Department of Otolaryngology – Head and Neck Surgery at the University of Cincinnati College of Medicine and UC Health.

Norberto Andaluz, MD, MBA, FACS – Professor of Neurosurgery and Otolaryngology/Head and Neck Surgery – Director, Division of Skull Base Surgery University of Cincinnati College of Medicine and University of Cincinnati Gardner Neuroscience Institute – UC Health

 

Click here to attend

Date: Wednesday, Sept 23, 2020

Time: 3:00 PM  Eastern Daylight Time

Learning objectives:

1.  To understand the surgical steps of endoscopic pituitary surgery
2.  To understand how the surgical steps of endoscopic pituitary surgery translate to post-operative outcomes
3.  To understand surgical factors that can modify post-operative outcomes after endoscopic pituitary surgery
4.  To understand post-operative care that can modify post-operative outcomes after endoscopic pituitary surgery

👥 Stanford Pituitary Patient Education Day

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The Stanford Pituitary Center invites patients with pituitary disease, their family and friends to Stanford’s Pituitary Patient Education Day!

May 18, 2019 at the Sheraton Palo Alto Hotel
625 El Camino Real
Palo Alto, CA 94301 
USA

Registration Contact:

Jennie Visitacion
E: JennieV@Stanford.edu
Ph: 650-725-4715

Topics and Breakout Sessions:

  • Function of the pituitary gland
  • General review of pituitary tumors
  • Endoscopic endonasal surgery for pituitary tumors
  • Quality of life after endonasal surgery
  • Radiation therapy for pituitary tumors
  • Cushing’s Disease, prolactinoma, and acromegaly
  • Hypopituitarism therapy and growth hormone deficiency

Speakers:

  • Olivia Chu, NP, Nurse Practitioner
  • Robert Dodd, MD, Associate Professor of Neurosurgery
  • Juan Fernandez-Miranda, MD, Professor of Neurosurgery
  • Andrew Hoffman, MD, Professor of Medicine
  • Peter Hwang, MD, Professor of Otolaryngology
  • Laurence Katznelson, MD, Professor of Neurosurgery and Medicine
  • Erin Wolff, NP, Nurse Practitioner

Course Directors:

Dr. Juan C. Fernandez Miranda

Juan C. Fernandez-Miranda, MD, FACS
Professor of Neurosurgery, and by Courtesy, of Otolaryngology – Head & Neck Surgery
Co-Director, Stanford Skull Base Surgery Program

Dr. Laurence Katznelson

Laurence Katznelson, MD
Professor of Neurosurgery and of Medicine (Endocrinology)
Medical Director, Pituitary Center

Webinar: Endoscopic Endonasal Surgery for the Treatment of Cushing’s Disease

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Mon, Jun 13, 2016 11:00 AM – 12:00 PM EDT

Show in My Time Zone
Presented by:
Dr. Maria Koutourousiou

Webinar DescriptionAn update on the diagnosis and treatment options of Cushing’s disease. Description of the endoscopic endonasal approach for the management of CD. Surgical videos demonstration and comparison with the microscopic transsphenoidal approach. Surgical outcomes and adjuvant treatment.

Presenter Bio

Dr. Mary Koutourousiou is an attending Neurosurgeon and Assistant Professor at the University of Louisville. She is the Director of the Pituitary and Skull Base Program. Dr. Koutourousiou received her M.D. from the Aristotle University of Thessaloniki, Greece and completed her neurosurgical residency at the General Hospital of Athens “G. Gennimatas”, in Greece. She underwent subspecialty fellowship training in Endoscopic Pituitary Surgery and Minimally Invasive Neurosurgery at the UMC St. Radboud, Nijmegen, in the Netherlands. She moved to the United States in 2010 and completed four years of research and a clinical fellowship in Endoscopic and Open Skull Base Surgery at UPMC Presbyterian in Pittsburgh, Pennsylvania.

Dr. Koutourousiou has published extensively in the field of endoscopic skull base surgery. Her studies have been presented in national and international neurosurgical meetings. Dr. Koutourousiou’s work in skull base surgery has been recognized by the European Skull Base Society and the World Federation of Skull Base Societies.

Register here: https://attendee.gotowebinar.com/register/4982773766837282305?utm_source=newsletter_199&utm_medium=email&utm_campaign=webinar-announcement-endoscopic-endonasal-surgery-for-the-treatment-of-cushing-s-disease