Gamma knife failure

[HavahJ]

Gamma knife failed on my small skull metastasis. Has anyone heard of the skull doctor, Dr. Shahinian?

[HavahJ]

Someone has made this site almost too complex to use.

[Lani]

Physician Profile

Hrayr K. Shahinian, MD
Director of the Skull Base Institute

“This is not just a job. It’s not a profession. It’s a passion . . . And in the end, I get a huge reward because we’re making such a tremendous difference in somebody’s life.” Hrayr K. Shahinian

The surgical techniques employed by Hrayr Karnig Shahinian, M.D., director of the Skull Base Institute are not easily categorized by traditional, preconceived specialties. They are, in fact, a combination of techniques from several areas-a hybrid-that have enabled him to develop innovative approaches that may be available at no other site in the country.

By becoming proficient in several specialties, Dr. Shahinian has acquired a set of skills that is perfectly suited to treating problems that occur at the base of the skull. Just as importantly, he is encouraging the nation’s medical community to look at specializations in a new way, says Robert Beasley, M.D., professor of surgery at New York University and a noted plastic surgeon specializing in hand surgery.

According to Dr. Beasley, the Skull Base Institute is recognized as being among the first centers in the United States to move from the traditional method of defining surgical specialties by the body’s systems to the more practical method of identifying specialties by regions of the body.

“It’s a very sophisticated situation,” says Dr. Beasley. “Dr. Shahinian prepared first in general surgery, then in plastic surgery and microsurgical techniques in plastic surgery, and he later trained in Europe with an otolaryngologist. He has drawn upon allied specialties that are appropriate for his particular regional specialization.”

Dr. Beasley says he has closely followed Dr. Shahinian’s progress because both men attended Vanderbilt University, although at different times, and Dr. Shahinian received his training in plastic surgery at New York University where Dr. Beasley was involved in his education. He has enough confidence in Dr. Shahinian’s skills that when a member of Dr. Beasley’s family needed surgery for trigeminal neuralgia, a condition in which the fifth cranial (trigeminal) nerve becomes pinched by a blood vessel, Dr. Shahinian was his surgeon of choice.

While other surgeons perform microvascular decompression to treat trigeminal neuralgia, Dr. Shahinian’s team is the first to do the procedure endoscopically, inserting a small scope into a dime-size opening behind the ear. Using the scope and microsurgical instruments, Dr. Shahinian is able to separate the vessel from the nerve and place a small Teflon disk between the two-without disturbing the brain. This minimally invasive but time-consuming procedure provides immediate and complete relief from an excruciatingly painful condition. Patients go home after about a 48-hour hospital stay.

In addition to correcting nerve and vascular problems, Dr. Shahinian treats infants who suffer from craniosynostosis, a premature fusing of the skull which would otherwise restrict growth of the brain. The majority of Dr. Shahinian’s patients, however, come to him for the removal of various types of tumors, especially those located in the area of the pituitary gland. The Skull Base Institute is one of only two centers able to remove pituitary tumors in a procedure that borders on same-day surgery.

“We put a 2.7 millimeter telescope into the nostril and take the tumor out through the nose,” says Dr. Shahinian. “There are no incisions, no scars, and the duration of surgery is shortened because we don’t have to do the full approach anymore. There are fewer complications and patients go home the next morning.”

“Dr. Shahinian has unique and unmatched surgical skills,” says Achilles A. Demetriou, M.D., Ph.D., chairman of the Department of Surgery at Cedars-Sinai. “He has developed and is leading the first free-standing division of skull-base surgery in the country. In addition to being innovative, it offers the best possible care in the management of complex skull base and craniofacial problems.”

Dr. Demetriou says the two became acquainted in the mid-1980s when Dr. Shahinian began his surgical training at Vanderbilt University, where Dr. Demetriou was a professor. “He was my resident at Vanderbilt. I knew him from the first day he started his training there. He was a star and it was clear to everyone that he was destined for greatness from the beginning.”

Born in Beirut, Lebanon, Dr. Shahinian spent most of his childhood and youth in Paris. His family traveled extensively because his father, Karnig, was a civil engineer involved in projects throughout the Middle East and Africa. His father, mother, Maro, and two younger sisters, Lara and Houry, still live in France.

“My dad was a very strong influence on me, fighting every battle and providing inspiration,” says Dr. Shahinian. “When I was very young, he guided me through schools and pushed me to do well.”

Consistently recognized for academic achievement throughout his education, Dr. Shahinian received a bachelor’s degree with distinction in biology and chemistry from the American University of Beirut before earning his medical degree, also with distinction, from both the American University of Beirut and the University of Chicago’s Pritzker Medical School in 1985. While in medical school, he had the distinction of earning membership in the prestigious Alpha Omega Alpha honor society. Dr. Shahinian served as a research associate in the University of Chicago’s Department of Surgery for one year before completing his training in general surgery at Vanderbilt.

From 1991 to 1994, Dr. Shahinian completed fellowships in three different specialty areas. At New York University Medical Center’s Institute of Reconstructive Plastic Surgery, he specialized first in plastic and reconstructive surgery, then in craniofacial surgery. Next he went to the University of Zurich in Switzerland and concentrated on skull base surgery in the Department of Head and Neck Surgery.

Crossing specialty lines can be difficult, he admits, because he no longer fits into one category or another. Still, he wouldn’t have it any other way.

“I realized early on that one specialty could not get me where I wanted to go,” he says, comparing his “hybrid” education to the cross-training that keeps athletes at the peak of their game. “This is not just a job. It’s not a profession. It’s a passion.”

Passion or not, long, tedious hours peering through the scope into the recesses of a patient’s skull can be exhausting. But Dr. Shahinian thrives on putting his skills to the test.

“I love the technical challenge,” he says. “I like things that are very demanding. And in the end, I get a huge reward because we’re making such a tremendous difference in somebody’s life. This is where I get my kicks. First, in the technical challenge, and more importantly, in the outcomes.”

Prior to launching the Institute in October of 1996, he simultaneously served as attending surgeon at the United States Department of Veterans Affairs Medical Center in Northport, N.Y., assistant clinical professor at the Institute of Reconstructive Plastic Surgery at New York University Medical Center in New York City, and assistant professor of surgery and neurosurgery at the State University of New York at Stony Brook.

Dr. Shahinian received the Harwell Wilson Award for Excellence as a Surgical Resident while at Vanderbilt University Medical Center, and has earned several teaching awards. He has written numerous journal articles as well as a chapter on skull base surgery in the text “Grabb and Smith’s Plastic Surgery.” He is involved in research projects on a variety of subjects, including pituitary cell transplantation and endoscopic skull base surgery.

“He is unique in his accomplishments, in terms of abilities, talents and integrity,” says Dr. Beasley. “I’m proud to have possibly made a small contribution somewhere along the way, encouraging him to go out and buck the system and show what could be done. Now, even though the Institute has been open only a few years, he sees patients from all over the world.”

[Lani]

knowledgeable about brain mets from her2+ bc (perhaps also skull mets)
who uses both cyberknife and gamma knife and is knowledgeable about which cases are better dealt with with surgery and in what way-- before deciding how to proceed may be in order.

On the West Coast, since you are thinking of consulting skull base surgeon Dr. Shahinian at CedarsSinai in Los Angeles, such a person from what I can gather is Penny Sneed, MD of UCSF

Did I miss whether your skull mets are near the skull base or elsewhere on the skull?

Hope some of this helps

[gin-tx]

I agree. Need a cheat sheet for all the symbols and areas to click on.

ginkott1@aol.com

[tousled1]

I'mDr. Shahinian sorry that the GammaKnife did not work on your skull met. I don't have any infor on Dr. Shahinian.

[pattyz]

Havah...

Try this: http://www.bcmets.org/

Very easy to 'negotiate'.

A site devoted to bc mets. We have a very large contingent of metsters there... someone may have had a similar experience to share.

best to you,
pattyz

[RhondaH]

I'm sorry your going through this and hope you find the help you need. I for 1 find the HER2 Support Group site VERY easy to navigate and would NEVER think of criticizing all of Joe and Christines work AND basically putting down (not you Havah) this site and encouraging use of another (while there are MANY good and useful bc support sites, I find it RUDE to not only criticize, but to encourage the NOT using of this site for the USING of another)...if you don't like this site, don't use it. Don't put down others hard work...THERE.

Rhonda

[hutchibk]

I am curious what you are looking for on this site that you find complex? A cheat sheet is needed for symbols and areas to click on? I personally only see very clear, self-explanatory and definitive words to click on, and I am one of the least 'techie' people on the planet. Perhaps what you are looking for is not contained in this site. If you don't find the info here, I say google it. You will find mounds of info doing that. This site is very "experience based" and if very few have had the experience of skull mets, you might find limited info here regarding skull mets. But you have done the best thing by posting the question...

I easily found this info here...http://bonetumor.org/
and this...http://her2support.org/index.php?option=com_content&task=view&id=45&Itemid=68
and this...http://www.her2support.org/bone2.htm
and this...http://her2support.org/a/elekta.htm

Do you know for sure that the Gamma failed? From what I understand, it sometimes takes many months for the site to shrink and the tumor to slough off. When did you have the Gamma?

Best of luck on your journey.

[Brenda_D]

I find this site very easy to navigate too. ??

[lilyecuadorian]

easier then this site,you can't find anywhere else

[Lolly]

I think some of the responders to HavahJ's thread aren't taking into account the fact that some brain metsters have vision and cognitive difficulties associated with their treatments, especially WBR, that may make it harder for them to navigate and also some aren't as computer savy as others, plus if one doesn't have high speed internet it can be extrememly frustrating.
We all appreciate Joe and Christine's work. I don't think they are offended if we frequent other sites for whatever reason.