Neurosciences at MUSC: An Overview
Guest: Dr. Sunil Patel – Neurosurgery, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Sunil Patel, who is Clinical Director, Chair, of the Department of Neurosciences here at the Medical University of South Carolina. Dr. Patel, in an earlier podcast, we talked about this very exciting procedure that you’ve been a pioneer in developing; the endoscopic removal of tumors of the base of the brain through tiny incisions up through the nostril, using endoscopy. I’d like to, maybe, for the sake of posterity, hear you talk about your role in developing this procedure. When did you first become involved? Just walk us through that journey, please.
Dr. Sunil Patel: When I first came to MUSC, I was trained in doing skull base surgery, and my role was to develop the Neuro-oncology and Brain Tumor programs. I was initially the director.
Dr. Linda Austin: And that was, when?
Dr. Sunil Patel: That was in 1993. The idea, at that time, was to develop a collaborative program where we’re managing brain tumors both in terms of malignant brain tumors, and also developing skull base surgery, which is sort of a collaboration of Head and Neck Surgery, Radiation Oncology, and Neurosurgery. But, from a much earlier point and, of course, with a good bit of support, my chair then, I became very interested in endoscopy as a technique; again, learning from others, and trying to minimize the approaches we used to develop it. So, it helped, very much, to have that type of collaborative atmosphere where you can try new things and develop new techniques.
Over the years, we developed a pituitary center, in which we became one of the first pituitary tumor centers in South Carolina. We began to see a lot of patients with pituitary tumors, which gave us a perfect opportunity to refine the techniques that we were using to remove these tumors, and endoscopy became very useful with that. I have to say, being at MUSC, this has allowed us to collaborate with industry. A lot of endoscopic instruments have been made for endoscopy, and other areas of the body. But, being where we are, I had the good fortune to collaborate with some of these companies in innovating. And, again, together, with my colleagues in Head and Neck Surgery, we really push the envelope, and really pushed industry in saying, you guys are behind; you need to catch up to our vision about what we would like.
I think it’s the atmosphere; the academic atmosphere, the atmosphere of discovery, that’s really helped me to push this. As I gained rank and moved up the ladder, this really became an important focus for me. And it’s been an enjoyable ride so far.
Dr. Linda Austin: Now, when did you first start using endoscopy as part of your surgical technique?
Dr. Sunil Patel: I started using endoscopy, probably, about 12, 13 years ago, and became very interested in it. We were already doing operations through the nose using a microscope and standard techniques; we made big openings. There’s was a little dissatisfaction with what we were able to achieve. At that time, I remember that at the end of an operation, I’d bring the endoscope just to see how the then available endoscopes were doing, and we started to modify our instruments. And, pretty soon, that’s all we were using; the endoscope, for these types of tumors. So, it’s been about 12 years that we’ve used the endoscope almost exclusively.
Dr. Linda Austin: Dr. Patel, what, specifically, have you and others at MUSC contributed in this field? I know that we are leaders nationally, if not world wide, in this area. What have our contributions been?
Dr. Sunil Patel: In terms of neuro-oncology, I think we’ve been leaders, again, in skull base surgery. We’re certainly at the leading edge. Our skull base surgery team; it’s not a one-man team, has been in leadership in skull base surgery for over a decade now. We’ve had a very strong collaboration between Neurosurgery, in the Department of Neurosciences, as well as the Otolaryngology department. So, almost all the skull base tumor cases in the South Carolina region have always been referred to us.
But, nationally, we’ve got representation at all the national associations, in neuro-oncology and skull base surgery, and head and neck surgery. So, we’re certainly a voice to reckon with. The people at academic meetings are looking at us for new ideas that we may have tried, and that sort of stuff. I think the other area that we’re really strong with, in neuro-oncology, and neurosciences, is in the treatment of malignant brain tumors, and new delivery techniques into the brain for drugs, but that’s another topic.
Dr. Linda Austin: What does the future hold here, in our Department of Neurosciences, of which you are the clinical chair?
Dr. Sunil Patel: Lots and lots of new things. Gosh, talking about neurosciences, the brain was the final frontier. And it will always be the final frontier. It was a decade ago. But, at MUSC Neurosciences, we feel like it’s the century of the neurosciences. We’ve put together; thanks to the College of Medicine, and the vision of the dean, a Neurosciences department built on collaboration between clinicians and researchers; everybody is in one big department. That’s allowed us to really attract people who are innovative, thought leaders, visionary, and very powerful researchers, and give them the opportunity to work with clinicians. We’ve developed a nationally reputable epilepsy center because of that.
We’re not just doing the best epilepsy in the country, but also looking at new ways to treat epilepsy with, again, minimally invasive techniques. We’ve also developed one of the first Stokes centers in South Carolina. And, really, looking at how we can take this top notch care; not just do it MUSC, and spread it around, we’re at looking ways to expand the role of telemedicine. For example, how can a patient with stroke in Bamberg still get as good of treatment as a patient who comes through the emergency room at MUSC, and how can telemedicine contribute to that?
We’re also doing a lot of trials. The Department of Neurosciences, right now, has 72 clinical trials in a variety of disorders of the brain, from aging disorders to stroke, to neuro-oncology, epilepsy, and movement disorders. So, it’s, really, an exciting time. Sometimes, on a day-to-day basis, it’s really hard to keep up with the faculty we have because they’re all busy doing wonderful things.
Dr. Linda Austin: Thank you so much and good luck in your future research, and clinical work.
Dr. Sunil Patel: Thank you.
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