PNA Spotlight: Dr. Zachary Litvack

Zachary Litvack MD bioDr. Zachary Litvack is Co-Chair of Neurosurgery and Director of Skull Base and Endoscopic Neurosurgery at the Swedish Neuroscience Institute in Seattle, WA. He completed his Bachelor of Science degree in Bioorganic Chemistry/Molecular Biology and his medical degree at Brown University. Dr. Litvack then moved to Portland, OR to attend Oregon Health & Science University where he completed an internship in general surgery, a residency in neurosurgery, and a master’s degree in clinical research from the NIH -supported Oregon Clinical & Translational Research Institute. Following his general neurosurgery training, he spent an additional year in pituitary surgery and neuro-endocrinology under the direction of Dr. Edward Laws in Boston, MA. Dr. Litvack has performed more than 300 pituitary operations, and has participated in more than 600 endoscopic endonasal operations in the course of his career. He has been an invited presenter on endoscopic skull base surgery at multiple universities, hospitals and international conferences. At Swedish, he trains one neurosurgical fellow each year in skull base and minimally invasive cranial surgery (including pituitary surgery).

What inspired you to choose your career path?

I can’t think of any profession more fulfilling than being a physician, and being able to help someone physically and emotionally feel better. Like many others, being a doctor was simply something that I always wanted to do. Once I started medical school, I always found the nervous system to be the most complex and most fascinating. Despite advances in molecular biology, neuroanatomy and neurophysiology, we still don’t quite understand how the sum of the parts works together. I've been a "tinkerer" my whole life, building and fixing things, and so I suppose it was inevitable that I would bring all of these interests together as a neurosurgeon.

What is the primary focus of your work/research?

I would love nothing more than to put myself out of a job. What I mean by that is that every scientific and clinical advance we make should make treatments more effective, less invasive and lower risk. Just in the time since I've completed medical school, I've seen diseases go from surgically or medically "managed" to cured with targeted therapy. Right now, I am focusing on advancing endoscopic and minimally invasive applications for brain tumors deep below the surface of the brain, and using fluorescent markers to help surgeons visually differentiate tumor from normal functioning brain tissue. This is important for identifying abnormal tissue in the pituitary from normal gland, especially for patients with Cushing's disease and acromegaly.

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

Right now, we have one pituitary tumor that can be medically cured in some patients – the prolactinoma. Recently, genetic markers have been identified in a subset of craniopharyngioma (a tumor that occurs in or next to the pituitary gland) which make it vulnerable to targeted inhibition therapy used in other cancers. I think we are on the cusp of a greater understanding of the key genetic steps towards formation of most of the tumors in and around the pituitary gland, and I believe it is inevitable that there will be a progression towards more medical inhibitor therapy and less surgery. However, until that happens, my focus is to continue to make surgery for pituitary tumors safer, more effective and ensure an easier recovery.

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

I cannot stress enough how important it is for patients with pituitary and related disorders to find a multi-disciplinary team to manage their condition. For many patients, diagnosis of a pituitary disorder is the beginning of a lifelong journey of living with their condition. Monitoring and managing this takes a large multi-specialty team. While the experience and skill of the surgeon is important, centers of excellence wherein the surgeon(s) work(s) closely with a larger team of specialists (neuro-endocrinologists, neuro-radiologists, neuro-pathologists, ENT surgeons, neuro-ophthalmologists and radiation oncologists) will do a better job of taking care of the whole patient - not just executing the operation. This is the model we adhere to at Swedish.

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

I get to spend my day helping people feel better, restoring function and quality of life, and teaching other physicians to do the same. I really do think I have the best job in the world! I don't take what I do every day for granted, and consider it a true privilege that patients are willing to trust me and my team to care for and operate on them. My commitment in return for this privilege is to provide the absolute best care for each individual.

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

One of my first interactions the Pituitary Network Association was helping to coordinate a Pituitary Patient Day symposium in Boston in 2010. I was so impressed with the professionalism and commitment of the patients, volunteers and staff. Since then, I have relied on the PNA nearly every day as a trusted resource of information for my patients. My patients have benefited from the PNA’s approach in partnering patients with trusted experts, and in patient-to-patient peer support as they navigate their diagnosis. I look forward to continuing to give back to this community in any way that I can!

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