We sat down with Moffitt’s newest faculty member on the Neuro-Oncology team, Dr. Andre Beer Furlan, to learn about his unique skills in endoscopic endonasal and minimally invasive surgery to treat skull base lesions and complex brain tumors.
Why are you excited to be part of the team at Moffitt Cancer Center?
Moffitt’s work environment is unique. In addition to providing outstanding patient care, the institution is at the forefront of clinical and translational cancer research. Most importantly, Moffitt succeeded in bringing together a group of very talented and compassionate individuals that work together for a common goal. It is very exciting to contribute and be part of it.
What is it about neurosurgery, with regards to skull base surgery, that interests you?
The skull base is an anatomically complex region where blood vessels, cranial nerves and brain structures are clustered together. Skull base surgery interests me because it demands a deep understanding of three-dimensional anatomy and how these neurovascular structures are altered and displaced by a tumor. Additionally, each patient is unique in regard to their tumor characteristics and treatment goals. Hence, it is crucial to tailor surgical and non-surgical treatment strategies to provide a personalized treatment plan. Finding the best strategy to help an individual patient is a very motivating process for me.
What are some of the procedures you’ll be performing at Moffitt?
My expertise is in the use of expanded endoscopic endonasal approaches (EEA), minimally invasive surgery to treat benign and malignant skull base lesions, complex brain tumors including pituitary adenomas, Rathke’s cleft cysts, epidermoid cysts, pineal region tumors, meningiomas, schwannomas, chordomas, chondrosarcomas, craniopharyngiomas, paranasal sinuses tumor, and olfactory neuroblastomas.
Why is this a unique offering at Moffitt?
For decades, the nasal corridor was only used in a limited approach to perform pituitary tumor resection. The development of the expanded endoscopic endonasal approaches (EEA) allows the nostrils and nasal sinuses to be used as natural corridors to remove skull base tumors utilizing a high-definition surgical telescope. This surgical route enhances patient recovery and allows safe tumor resection without incisions in the face or scalp while minimizing brain tissue retraction and manipulation.
The evolution of the expanded EEA was a result of a better understanding of the skull base anatomy, reconstruction techniques, endoscope use, and the development of new surgical instrumentation. However, the technique is still not as widely used as it should be.
Minimally invasive approaches are technically demanding and are not suited for all types of tumors and skull base locations. Hence, it is very important to find a team with significant surgical expertise and specialized instrumentation for optimal treatment decision-making. Depending on tumor type and location, an open conventional surgery may still be the best approach to achieve the treatment goals.
What is your research interest?
My research interests include patient’s quality of life and outcomes after endoscopic endonasal and keyhole surgical approaches, prognostic biomarkers for skull base tumors, and super selective endovascular drug delivery for brain cancers.
Where do you see the future of skull base surgery (novel treatment, innovative surgery, clinical trials, etc.)?
From a technical standpoint, I believe the next revolution in skull base surgery will come with robotic surgery. Surgical robots currently available are too large for neurosurgical applications. Nevertheless, it will be a matter of time until we see miniature size robots that will fit through the patient’s nostrils.
In addition, neurosurgery and its subspecialties have been moving toward less invasive treatments and procedures. In the distant future, I believe we will be able to treat most of the brain and skull base tumors with targeted chemotherapy and biologic therapy delivered in a minimally invasive manner.