Skull Base and Endoscopic Microdissection Laboratory and Lecture

The Skull Base and Endoscopic Microdissection Laboratory and the 2nd Annual Clinical-Pathologic Conference
Providence Saint John’s Health Center in Santa Monica, CA

March 17, 2017: In 2012, Garni Barkhoudarian, MD, established the Minimally Invasive and Endoscopic Microdissection Laboratory at the Saint John’s Cancer Institute at Providence Saint John’s Heath Center. As director and expert neurosurgeon, he trains clinical and international fellows on the subtle aspects of surgical brain anatomy. At this year’s Clinical-Pathologic Conference and Annual Brain Microdissection Lecture and Lab, Dr. Barkhoudarian, was assisted of Dr. Santosh Kesari, pathologists Drs. Yuki Takasumi and Winnie Wu as well as medical artist, Josh Emerson. Demonstrating Saint John’s Cancer Institute (formerly Saint John’s Cancer Institute, JWCI) and Pacific Neuroscience Institute’s (PNI) commitment to team collaboration and education, the popular conference series was well attended by a wide range of lab personnel from the Departments of Translational Molecular Medicine and Translational Neurosciences and Neurotherapeutics, clinical staff, JWCI clinical coordinators, and various surgical fellows.

The morning began at JWCI with a lecture on brainstem embryogenesis and how it affects a surgeon’s approach to patient brain tumors. Sharing his expertise as a specialist in skull base and minimally invasive brain surgery, Dr. Barkhoudarian detailed the importance of understanding the brainstem’s embryonic development as it directly correlates with the functionality of specific nerves based on location. There is a significant amount of strategy and planning that occurs well before the patient gets to the operating table, and depending on tumor location, a different surgical approach may be used to preserve the nerves, and therefore the functions present in those areas. Dr. Barkhoudarian stated that this is only one of many factors considered when developing a strategy for brain tumor removal.

Following the lecture, the group moved to the Microdissection Laboratory at Providence Saint John’s for the lab portion of the day, which included the brain dissection of one of Dr. Kesari’s former patients. Dr. Barkhoudarian continued his instruction of brain anatomy then handed over the reins to Dr. Kesari, who went over the relevant clinical background of the brain specimen. The patient was originally diagnosed with an extremely aggressive form of breast cancer that rapidly metastasized throughout the body and eventually to the brain. MRI scans of the patient’s brain from earlier that year showed no sign of cancer, proving that the uncountable number of small tumors throughout the brain had occurred within a matter of months. Dr. Kesari, who has extensive experience with all types of malignant brain tumors, explained that brain metastases are becoming an increasingly common problem due to most anti-cancer drugs lacking the ability to cross into the brain due to the blood-brain barrier.

These kinds of clinical conference series offer the opportunity to analyze patient cases in a supportive and instructional environment conducive to learning from experience. Discussion focused on understanding why administered treatments didn’t work, what new anti-cancer drug pathways could have been explored, and what steps might be taken to work towards successful clinical outcomes in patients with similar prognosis.

The Microdissection Lecture and Lab demonstrates the benefits of PNI’s multidisciplinary approach to tackling and treating cancer. Academic research and clinical teams work together to truly understand cancer by constantly communicating and sharing their expertise. Idea exchanges lead to the development of strategies that span multiple disciplines, offering direction for future translational research projects and eventually resulting in better treatment approaches.

The Microdissection Laboratory is sponsored by Karl Storz Endoskope North America, Stryker Corporation, Mizuho Medical company Ltd, Surgical West Inc. and Providence Saint John’s Health Center. Generous funding is provided by the Westervelt Family and the Amendjian Family.

Emily Schoof is a research associate with the Department of Translational Neurosciences and Neurotherapeutics. Her work in Dr. Santosh Kesari’s lab helps uncover pathways and mechanisms that contribute to the development of brain cancer.