Meet Nathan

Raised on a family hog farm in western Michigan, Nathan Zwagerman, MD, assistant professor of neurosurgery at the Medical College of Wisconsin (MCW), was almost destined to be a farmer.

“As far back as I can remember, I always worked on the farm,” Dr. Zwagerman told Milwaukee Journal Sentinel columnist Jim Stingl during an interview published in 2018.

But he wasn’t a fan of pork, he said half-jokingly during the interview, and it seems that he was destined not to work with animals, but with humans, and patients in Wisconsin are better off for it.

Dr. Zwagerman joined MCW in 2017 after completing his residency and fellowship training at the University of Pittsburgh. He arrived at MCW as one of only a handful of surgeons who specialize in removing meningiomas and other brain tumors using a rare technique.

“Sometimes we do surgeries through the nose, or through a crease in the eye, or behind the ear,” he says, describing methods he has used to minimize the invasiveness of surgery.

Typically, removing tumors in the head is done through a craniotomy, or surgical incision into the skull. But those surgeries don’t attack the area that supplies the tumor with blood, leaving a greater chance that a tumor could return, Dr. Zwagerman explains. Smaller operations that attack those blood supplies have been shown to reduce hospital stays and improve patient outcomes after surgery, he adds.

One of those patients is Margaret Rondeau, who had endonasal surgery to remove and cut off the blood supply of a meningioma, which had damaged her vision and was greatly impacting her quality of life.

“I feel that I have my full capacity back now,” says Rondeau, a pastoral associate.

Dr. Zwagerman describes the minimally invasive procedures as “keyhole” surgeries because even though you’re peering into a small hole, you can still see a larger area.

“Instead of doing a big, large opening in the skull, we make smaller openings and use things like cameras and microscopes into these smaller areas so we can see where the tumor is,” he explains.

Dr. Zwagerman employs these types of approaches in select patients, dependent on the tumor, its blood supply and how it’s impacting the nerves or brain itself. If a tumor is amenable to minimally invasive techniques, then he uses them. If not, then he finds an alternative form of treatment.

It’s a process that continues to evolve, as Dr. Zwagerman is currently part of several research projects. One involves anatomy and looks at patient outcomes after surgery. Getting a better understanding of the anatomy helps surgeons understand where you can and can’t go safely, he says.

Another project he is involved in is aimed at improving imaging technology. Better imaging, he explains, will allow for a greater ability to identify cranial nerves that are within tumors.

“When I can predict where the tumor is in relation to the nerves. it helps me protect those nerves better,” Dr. Zwagerman says.

Perhaps it’s the farm work ethic he was raised with that drives Dr. Zwagerman to work as hard as he does, but his objective is simply to help others.

“Ultimately my goal is to take care of patients and to make sure that they do well. That’s what I’m here for,” he says.