PNA Spotlight: Drs. John Boockvar and Peter Costantino

This month the PNA Spotlight focuses on two surgeons who work side-by-side at the New York Head and Neck Institute at Lenox Hill, part of Northwell Health: Drs. John Boockvar and Peter Costantino.

John Boockvar

Dr. Boockvar is vice chair of the Department of Neurosurgery at Lenox Hill Hospital, and is Director of the Brain Tumor Center and the Pituitary/Neuroendocrine Center of the Department of Neurological Surgery and the New York Head and Neck Institute at Lenox Hill and Manhattan Eye, Ear and Throat Hospitals. He is also a Professor of Neurological Surgery and Otolaryngology/Head and Neck Surgery at Hofstra Northwell School of Medicine, and an investigator at the Feinstein Institute for Medical Research where he directs the Laboratory for Brain Tumor Biology and Therapy. He did his undergraduate work at the University of Pennsylvania and received an M.D. from SUNY Brooklyn-Downstate Medical Center. Dr. Boockvar did his surgical internship and neurosurgical residency at the Hospital of the University of Pennsylvania and did his post-doctoral research training in Neuro-oncology at the University of Pennsylvania Cancer Center, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College.

 

Peter CostantinoDr. Peter Costantino is the Chairman of the Department of Otolaryngology-Head and Neck Surgery at Lenox Hill Hospital-Manhattan Eye, Ear and Throat Hospital, and for the Hofstra-Northwell School of Medicine. Additionally, he serves as the Executive Director of the New York Head and Neck Institute, and Senior Vice-President of the Otolaryngology-Head and Neck Surgery Service Line of Northwell Health. He is also the Director of the Health System’s Center for Cranial Base Surgery. Dr. Costantino got his M.D. and did residencies in otolaryngology and general surgery at Northwestern University. He did a fellowship in cranial base surgery at the University of Pittsburgh and another in head and neck surgical oncology and reconstructive surgery with the American Cancer Society.

Drs. Boockvar and Costantino were kind enough to answer a series of questions from the PNA. Dr. Boockvar’s answers are printed first, followed by those of Dr. Costantino.

Dr. John Boockvar:

Q: What inspired you to choose your career path?

A: I am a fourth-generation physician. Having medicine in your family is an incredible advantage when pursuing this career choice, as you get exposed to the rewards and challenges of life as a doctor or surgeon. As an undergraduate at the University of Pennsylvania, I became entranced with the study of neuroanatomy. Once I got to medical school, I knew I was going to become a neurologist or neurosurgeon. I quickly figured out that surgery was for me and I worked hard to succeed in medical school so that I could secure a residency in neurological surgery. As a resident at UPENN, I worked in a brain tumor laboratory, where I realized that the subspecialty of neuro-oncology was both challenging and rewarding; and such it became my career focus.

Q: What is the primary focus of your work/research?

A: The primary focus of my work is in the treatment of brain tumors, both benign and malignant. I study and treat benign brain tumors such as pituitary tumors and meningiomas. I also treat a host of malignant cancers including gliomas and metastasis.

Q: What do you consider to be the future of your field?

A: The future of our field is harnessing our body’s own immune system to help provide surveillance against and treatment for the body’s brain tumors. As scientists and surgeons, we are continuing to look at ways to enhance our body’s defense system so that we can better defend against either new brain tumors or ones that are going to recur.

Q: What should patients know about your field/what deserves more recognition/awareness?

A: Our field is constantly evolving and we offer many clinical trials to patients with either benign tumors or malignant cancers. For example, we have a host of clinical trials for our patients with pituitary tumors so that they may avoid surgery or even prevent a recurrence.

Q: What would you like to convey about yourself to your patients?

A: We work as a team. Dr. Peter Costantino and I do every case together and that provides exceptional skill and oversight for every patient. Dr. Costantino is not only a world-renowned endoscopic skull base surgeon, but an exceptional doctor who understands the needs of the patient. We bring great chemistry to every case and that type of camaraderie and skill allows us to achieve great outcomes for our patients.

Q: Why did you get involved with the PNA and what is the extent of your involvement?

A: I lost my father to cancer. I know how important associations, foundations and support groups are to both patients and family. Associations like the PNA provide patients and families with necessary information, access and support for pituitary diseases. In this age of misinformation, the PNA helps guide our patients not only to the best information, but the best treatment, that is affordable and close to home. It is an incredible resource.

Dr. Peter Costantino

Q: What inspired you to choose your career path?

I was inspired to become a skull base surgeon upon observing a single surgery during my 3rd year of medical school at Northwestern University. I had been struggling with the decision of going into neurosurgery, plastic surgery, or head & neck surgery. I always found head and neck, and neuroanatomy fascinating, as well as the challenge of facial reconstruction, and I just could not make up my mind. As I was about to leave for the day, one of my friends told me in the surgeon's locker room that "you have to see what they're doing in O.R. room #3...it’s amazing." So, I put my scrubs back on, went to room #3 and learned for myself how the newly created field of skull base surgery could meld together all of my interests. The surgery I witnessed was a "mandibular split procedure" for access to a skull base tumor. This is an older technique, rarely used today, where the jaw is cut at the chin and spread apart so that the very base of the skull (the clivus) could be accessed for tumor removal. It was an amazing surgical procedure, and was being performed by Dr. Yosef Krespi, one of the pioneers in skull base surgery... a man who would go on to become my mentor and a founding member of the New York Head & Neck Institute. From that evening on, I never looked back and went on to become certified in head & neck cancer surgery, facial plastic & reconstructive surgery, and otolaryngology. I now hold the title of Professor of Neurosurgery.

Q: What is the primary focus of your work/research?

I have two foci of research: 1) craniofacial reconstruction using new techniques and materials, and 2) new methods of ensuring complete pituitary tumor removal while still preserving the function of the pituitary gland.

Q: What do you consider to be the future of your field?

The future of skull base surgery will involve three distinct areas of development:

A) The eventual use of robots for skull base tumor removal. Current robots are too large to be used endoscopically at the skull base, but within the next 5 years this problem will begin to be solved. This will represent a major advance in skull base surgery.

B) Targeted fluorescent imaging dyes that concentrate in tumor tissue. These fluorescent dyes, given intravenously prior to surgery, will allow us to visualize tumors during surgery more accurately, leading to more complete removal.

C) Imaging contrast materials (such as PET scan contrast) that are linked to radioactive or chemotherapeutic drugs. These imaging contrast dyes combinations will concentrate in tumor cells, and the attached radioactive or chemotherapeutic drug will, in turn, also be concentrated in those same tumor cells, potentially leading to their death. This holds great promise for all types of skull base tumors, but particularly for pituitary lesions, adenoid cystic carcinoma, high grade meningiomas, and chordomas.

Q: What should patients know about your field/what deserves more recognition/awareness?

The most important thing to know about skull base surgery, and pituitary surgery, is the absolute superiority of a "multi-specialty team approach". The combination of a neurosurgeon and a head & neck surgeon (otolaryngologist) in the performance of successful pituitary surgery cannot be overstated. The skill of those two surgical fields are different, and not just complementary, but are actually synergistic. If someone needs pituitary or skull base surgery, they should only consider centers where a multi-specialty team approach is employed, preferably by surgeons who work together on a regular (nearly daily) basis.

Q: What would you like to convey about yourself to your patients?

The single thing that I would like to convey, and I know that I also speak for my partner, Dr. John Boockvar, is that we understand how stressful it is to learn that you have a pituitary tumor, let alone that you need surgery to treat it. I understand this stress because I've lived it...my wife had a chordoma 18 years ago and I've been in the patients’ shoes for years. So, if you choose our team, not only will you be selecting surgeons with decades of experience, but you’ll work with doctors who genuinely understand what you're going through on a personal level. We’ve lived it in our personal lives.

Q: Why did you get involved with the PNA and what is the extent of your involvement?

I became involved with the PNA due to the number of pituitary tumors that we remove on a yearly basis, which is substantial, coupled with the fact that the PNA is the pre-eminent organization for the education of patients suffering from pituitary tumors and disorders. It was a natural fit for our team to become involved with the PNA, and we support its work on behalf of patient education and outreach.

 

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