Finding A Balance

Gruppo Ospedaliero San Donato (GSD)

Life is all about balance. At least, that’s what a whole host of self help books, websites and motivational tapes will tell you. It’s easy to brush such statements off as being vapid and aspirational rather than the concrete advice people tend to look for. However, Professor Pietro Mortini, chairman of the department of neurosurgery and gamma knife radiosurgery at San Raffaele Hospital has, in many ways, managed to find a form of balance that suits him, his hospital and perhaps most importantly, his patients. 

His 49-bed department has two dedicated operating theatres, a gamma knife and treats around two and half thousand patients every year. In addition to its radio surgery and endovascular units, it is now ready to admit children and, Mortini is excited to say, “the next step is to be ready for foetal surgery” and that foetal surgery can be conducted on foetuses after just 26 weeks of gestation. Used to correct the most common spinal malformation, myelomeningocele, he is confident that it will be a big draw for patients from the Middle East where congenital defects are more common than in other parts of the world. The results from this foetal surgery are, he says, very promising with 50% of patients able to walk afterwards. 

Despite this new capacity for advanced foetal surgery, the bread and butter of the department remains neurooncology. Indeed, Mortini explains that around 65% of the department’s annual caseload is brain tumors. They are, he says, one of the largest centers in Italy and for some conditions they treat more cases than anywhere else in the world.

Professor Mortini’s “first and permanent scientific interest is intracranial tumors, specifically skull base tumors.” What makes tumors at the base of the skull more difficult, he continues, is the fact that the skull base is an area where there are a number of arteries and nerves that cross. “It is a very challenging area.” It is also, he says, an area where both traditional microsurgery and endoscopy can match up very nicely with radiosurgery. “Sometimes both should be combined to give the best results in terms of both disease control and quality of life.” He warns that there are surgeons that “operate to remove everything with bad results in terms of post operative functions.” However, through finding a balance between the two approaches, patients stand the best chance to have excellent results in terms of treating the disease as well as maintaining a good quality of life. 

He is also keen to highlight the research work his department undertakes. On the topic of skull base tumors he identifies ongoing research to develop novel technologies and even new drugs for any particular type of tumor. The department’s main focus, he says, is neurobiology. “We’re organizing a biobank to keep all the tumor tissue and we’ll start a number of projects on the biology and genetics of those tumors. We are also cultivating groups of specific cancer stem cells in order to study the effects of radiation and new drugs.” Even though we are neurosurgeons, he says, “we have very basic areas of research.”

In addition to the basic research conducted, Mortini explains his department’s work on using ultrasounds for intra-operative imaging. “We’re studying the application in reception of brain tumors. So far we’ve had excellent results.” It helps “increase the efficacy of surgery and increase the safety too.” Its value lies in the fact that it can be used “to study the structure of the brain which helps determine the extent of a tumor that is not visible under the operative microscope because, for example, the color is the same as the brain tissue.” Ultrasound then, allows for a better understanding of the shape and structure of the tumor. “It’s very simple, cost effective and gives more info than MRI for example.”

In thinking about how he approaches his work, Mortini says that the foundation of his approach is in putting the patient first. More than providing the best care for the patient, he says that it is about thinking of the long term results and not simply the short term. “To do that you should keep in mind that the only way for the modern surgeon is to see the numbers.” He recounts how a patient from once told him they had decided to be operated on by him because he is “a doctor who thinks like an engineer.”