Behind a desk covered in papers and brain-themed knick-knacks, Edward Laws, MD, opens a notebook containing a handwritten log. It’s one of several that contain a record of every surgery Laws has ever performed. In neat handwriting near the end of the list is an entry on his 6,000th transsphenoidal surgery over almost six decades. Since that milestone this May, he’s performed 14 more of these surgeries, which allow removal of pituitary growths via the nose and sphenoid sinuses.
When Laws became a neurosurgeon, he would have been happy to have completed 600 procedures. “I never imagined I would have performed 6,000 of them,” he said.
Laws has celebrated each milestone, and keeps the plaque commemorating his 100th surgery displayed in the Neurosurgery offices, along with photos from celebrations throughout his career. He commemorated this most recent milestone at the Brigham with his team in May.
A Man of Many Interests
Before he became a neurosurgeon, Laws studied economics and sociology while taking pre-med courses at Princeton University. He earned his medical degrees and began specializing in neuroencrinology at Johns Hopkins University, where he later became a resident.
In the late 1960s, Laws first learned about transsphenoidal surgery from his mentor, George Udvarhelyi, MD, at Hopkins. He continued to perform these surgeries during his career at Hopkins, Mayo Clinic, the University of Virginia and Stanford University. In 2008, he received a call inviting him to join the Brigham and revamp its pituitary program. “I thought about it for about 20 seconds,” remembered Laws, who accepted the position on the spot.
Laws was excited to join the Brigham, he explained, because the hospital played an important role in the history of pituitary surgery, a topic Laws often writes about. The influential Harvey Cushing, MD, founded the Brigham’s Pituitary and Neuroendocrine Program, where he helped to pioneer transsphenodial surgery. He later abandoned the approach, which fell out of favor in the U.S. in the 1920s. But with the advent of improved microsurgical technology decades later, European neurosurgeons revitalized the procedure and reintroduced it to a new generation of pituitary surgeons – among them, Laws’ mentor.
A Delicate Operation
Shortly after arriving at the Brigham in 2008, Laws completed his 5,000th transsphenoidal surgery. Today, he performs up to five surgeries a week, and he acts as director of the Pituitary and Neuroendocrine program here at BWH.
In transsphenoidal surgery, a physician inserts surgical instruments into the nose and up through the bone at the base of the skull. More direct and often safer than open-brain pituitary surgery, transsphenoidal surgery allows minimally invasive access to the pituitary – a hormone-secreting gland located at the base of the brain.
The pea-sized pituitary gland produces and releases hormones that influence many bodily processes, including growth, reproduction and blood sugar regulation. Pituitary gland tumors, unlike other tumors, rarely progress to become cancer. Laws is researching why this is. He hypothesizes that the distinct hormonal environment and extremely active cells of the pituitary somehow prevent cancer development.
Although usually benign, tumors and cysts on the pituitary can seriously disrupt hormone regulation and produce a wide array of symptoms, from gigantism to sexual dysfunction. Tumors that are big enough can also press against surrounding structures, causing headaches and vision loss.
To remove these disruptive growths, Laws looks through the nostrils with an endoscope, a tiny pencil-shaped instrument with a camera at the tip, to find the tumor. Using microinstruments, he then opens the bony shell encasing the pituitary called the sella and carefully extracts the tumor. He fills the resulting empty space with a gelatin sponge or fat from the abdomen.
“It’s a very delicate operation,” said Laws, but “the risk factor is pretty low. It’s about the same as having your gall bladder removed.”
After a successful surgery, Laws has high hopes for the patient to regain a normal life. Most patients who have lost their vision because of the tumor regain their sight after its removal. Hormonal abnormalities usually balance out over time, with the help of endocrine replacement therapy.
Recently, Laws operated on a young woman whose pituitary cyst caused her excruciating headaches. After Laws removed the cyst, the headaches subsided. “It’s very rewarding” to make such a positive impact on a patient’s life, he said.
The multidisciplinary nature of the Pituitary and Neuroendocrine program, Laws said, is crucial to the success of these surgeries. “That whole team is essential,” he emphasized, to coordinate the many steps involved in treating a pituitary tumor.
When a patient presents with a pituitary growth, endocrinologists first characterize and treat hormone imbalances. Otolaryngologists help navigate the delicate anatomy of the nose and sinuses, and colleagues in radiation/oncology lend expertise when radiation therapy is needed. The program has recently added neuro-ophthalmologists to the team to address patient concerns about vision loss.
The seamless coordination between these specialists is designed to make the patient experience as smooth as possible. Laws’ primary goal as director of the BWH program has been to create a “one-stop shop,” so patients can sail through the treatment process with efficient and friendly guidance to support them.
“I feel strongly that patients need to talk to somebody, not a menu on the telephone,” said Laws. “We’ve created a clinic experience where the essential experts are there at the same time, so it’s incredibly user-friendly.”
Laws believes a similar collaborative spirit in the research world is transforming the present and future of neurosurgery. “What we’re learning about the nervous system has been growing in leaps and bounds,” he said. “Collaboration and collegiality, I think, are responsible for a lot of that progress.”
In addition to being a gifted surgeon, director, educator and researcher, Laws is also a history buff, a writer and a self-professed grammar nerd. He collects models of bygone military planes, and he has written many books on the history of neurosurgery. He served as editor – alongside his wife, Peggy, as managing editor – of the journal Neurosurgery in the late 1980s. He and Peggy still collaborate by editing research manuscripts and Laws’ books. They have four daughters and six grandchildren.