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First Issue
By Richard Suh, M.D.
Current Research at the Skull Base Institute
Since the opening of the Skull Base Institute, Dr. Hrayr Shahinian has brought to Cedars-Sinai Medical Center new areas of basic science and clinical research. The Institute is involved in several projects, all in various stages of completion. Two interesting projects are the pituitary transplantation study and the cerebrospinal fluid autologous bypass study.
The pituitary transplantation study is an exciting project with far-reaching ramifications. The study was designed with the hope of treating patients who suffer from panhypopituitarism.The condition has multiple causes that range from medical, radiologic and surgical destruction of the pituitary gland. These patients remain on life-time triple therapy with steroid, estrogen/testosterone, and thyroid replacement. With this background, several researchers in Europe designed studies to transplant pituitary tissue cultures into an animal model. They documented their success by measuring detectable hormone levels. We have expanded this preliminary work by introducing human fetal pituitary cells into an animal model. The study is currently started and is being performed in collaboration with the Cedars-Sinai endocrinology research staff. Preliminary results are expected soon.
The lab has also begun work on an autologous bypass for cerebrospinal fluid. An animal model is being studied to research the viability of small bowel for the absorption of CSF. Preliminary studies show that graft survival is possible. This study may have more future applications in humans for the treatment of hydrocephalus.
We have also submitted several papers for publication in peer review journals:
- The first is a report of a new surgical technique. Tumors of the infratemporal and pterygopalatine fossil are rare, but can cause significant neurologic symptoms and severe pain.Traditionally, the size of the tumor has dictated the operative technique used for resection. Larger tumors required the use of a technique which incorporates the loss of hearing on that side. This technique has been particularly difficult for elderly patients who are at risk for continued hearing loss on the unaffected side. By using combined techniques unique to skull base surgery, we have been able to resect large tumors safely and effectively without hearing loss.
- Additionally, we have also submitted a case report of an interesting patient with papillary carcinoma of the thyroid gland metastatic to the skull base. The patient presented with progressive ataxia. Work-up revealed an isolated metastasis measuring 5.s cm to the posterior skull base. Metastases of papillary carcinoma of the thyroid gland to the central nervous system are rare and reported at less than 1 percent. Currently, published literature includes only anecdotal reports of metastasis to the skull base.
- Another report submitted involves the obstetrical factors in infants born with lambdoid synostosis. Craniosynostoses are disorders characterized by premature fusion of the cranial sutures. This leads to progressive deformities of the skull and displacement of the ear. We reported that infants who developed lambdoid synostosis had significantly longer duration of the first stage of labor. The study also showed predilection toward male infants, and association with pre-term labor.
Many other projects keep the research arm of the Cedars-Sinai Skull Base Institute busy and productive. Look to the future issues of this quarterly newsletter for more information on our progress.
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