Treatments | Andrew S Davidson

Multidisciplinary treatment:
an essential part of patient care

Surgery

Associate Professor Davidson has been extensively trained in all aspects of operative neurosurgery; he has completed the rigorous neurosurgical training program in Australia, resulting in the award of the Fellowship of the Royal Australasian College of Surgeons (FRACS) in 2008; he has also undertaken a comprehensive 3-year combined clinical and research Fellowship in cerebrovascular surgery with one of Australia’s most respected cerebrovascular neurosurgeons, Professor Michael Morgan.

Dr Davidson offers a range of surgical approaches, including traditional open microsurgical procedures, keyhole techniques for deep and difficult-to-access tumours, and extended endoscopic endonasal surgery for complex skull base tumours.

Some of A/Prof Davidson’s surgical procedures involve collaboration with neurosurgical colleagues, or with surgeons from other disciplines, including ENT, ophthalmology, head & neck surgery, and orthopaedic surgery. This multidisciplinary approach ensures that patients receive expert care from the most experienced team of surgeons for their particular condition, providing the best possible outcome from surgery.

Endoscopic surgery

For some tumours, particularly pituitary and anterior skull base tumours, the extended endoscopic endonasal approach provides a direct approach that would otherwise be extremely difficult to obtain through traditional transcranial surgical approaches. Operating with an ENT surgeon, the endonasal approach provides direct access to tumours through the nose without any cuts on the head. This approach allows the tumour to be removed without brain exposure or retraction, allowing for fewer neurological complications and a shorter length of stay than open approaches.

A/Prof Davidson collaborates with stroke specialists at Royal Melbourne Hospital to perform endoscopic removal of acute bleeding within the brain (hemorrhagic stroke), with the goal of improving neurological function after stroke and reducing length of stay in intensive care.

Dr Davidson also uses the endoscope to perform ‘keyhole’ resection of selected tumours and cysts from deep within the brain (e.g. intraventricular tumours, colloid cysts).

Gamma Knife

The Gamma Knife is a medical device used to deliver focused radiation to an intracranial target. It is a non-invasive alternative to open brain surgery for a variety of complex, difficult brain conditions.

The first ever Gamma Knife treatment occurred in Sweden in 1968. Over the next 50 years, more than 1.1 million patients have been treated around the world. The Victorian Gamma Knife Service at Peter Mac is the third Gamma Knife unit in Australia, and is the only unit in Victoria.

The Gamma Knife is run by a team of radiation oncologists, neurosurgeons, radiation therapists, radiation physicists, radiotherapy nurses, and allied healthcare providers. Cases are referred to the Victorian Gamma Knife Service by clinicians throughout the state of Victoria and are discussed at a State-wide Multidisciplinary Meeting (MDM).

A/Prof Davidson is the lead neurosurgeon for the Victorian Gamma Knife Service, and is the Chair of the State-wide MDM.

Oncology

Associate Professor Davidson works closely with a dedicated team of oncologists, cancer care nurses, radiation therapists, and allied health professionals at Royal Melbourne Hospital and Peter MacCallum Cancer Centre. These cancer specialists work with other members of the neuro-oncology multidisciplinary team (including neuroradiologists, neuropathologists, and cancer researchers) to improve care and clinical outcomes for cancer patients and their families.

All patients with a brain tumour are invited to participate in research, through participation in brain tumour banking, laboratory research projects, patient-reported outcome assessments, and the use of online information technology resources to enhance cancer survivorship.

Dr Davidson is the Chair of the weekly Gamma Knife MDM, and attends the weekly primary brain tumour, metastatic brain tumour, and melanoma brain metastasis meetings, as well as the monthly pituitary multidisciplinary meeting. These meetings are an extremely valuable part of multidisciplinary patient care.

Endovascular

Patients with vascular diseases of the brain and spine (aneurysms, arteriovenous malformations, and dural arteriovenous fistulas) are regularly discussed at the Royal Melbourne Hospital weekly cerebrovascular MDM. These meetings are attended by neurosurgeons, interventional neuroradiologists, and radiation oncologists with expertise in the management of these complex conditions.

A full range of surgical and endovascular treatment options are offered at Royal Melbourne and Peter Mac, including microsurgery, coiling, stenting, Onyx (glue) occlusion, endovascular clot retrieval, and radiation treatment (including Gamma Knife radiosurgery).

In cases where multiple treatment options exist, the relative risks, benefits, and expectations of each treatment are discussed in detail, before relaying this information to patients and their families to assist in shared clinical decision-making.