11th Workshop Endoscopic transphenoidal surgery, March, 2010

 

In this blog entry I will describe my impressions for a course I attended March 8-9: 11th Workshop Endoscopic transphenoidal surgery: from pituitary to skull base.

The workshop was held at Bellaria Hospital in Bologna, Italy. The course director was Dr Giorgio Frank and the faculty included neurosurgeons with very long experience within the field, for example, Dr Cappabianca and Dr de Devitis from Napoli, Dr Pasquini, Bologna and Dr Laws from Boston.  

Dr Laws, Boston, gave an interesting historical expose of the development of transphenoidal skull base surgery. Dr Laws has a very long experience within this field and has completed over 5,000 pituitary procedure (!).

One of the take-home messages from the course was that taking care of patients with piuitary adenomas is a team-work. Therefor there were lectures about endocrinology, neuroradiology and neuropathology.

The primary aim of the course was transphenoidal endoscopic surgery for adenomas but many lectures also dealt with extended approach making it possible to reach, for example, craniopharyngeomas, suprasellar meningeomas and germ cell tumors, and the cavernous sinus. 

Dr Castelnuovo, Varese, Italy,  gave a speach about sellar reconstruction. Many of the speakers later also returned to this interesting topic - how to prevent cerebrospinal fluid leakage after extended opening of the skull base. A multi-layer technique involving graft from fascia lata and mucoperiost was described. Some uses fibrin glue while other said it is not necessary.

The workshop included four live surgical procedures. For each surgical procedure a smaller group was allowed to follow the surgery in the OR. The rest followed the surgery from another room. Since the OR was equipped with an excellent camera and the separate room was equipped with a large screen projector and and large HD-screen it was very easy to follow the procedure. The cases involved both a straight forward pituitary adenoma but also more complicated cases involving suprasellar tumurs and opening of the cavernous sinus. 

The combination of lectures, discussions and live surgery made this a very interesting course that I definitively can recommend.

/Thomas S

 

A picture from the course in front of Bellaria Hospital, Bologna, Italy.

 

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Trans-sphenoidal surgery
written by sharmakchand, March 11, 2010
The technique is as old as modern neurosurgery itsef. Cushing and others did not pursue it because of entering through potentially source of infections from ethmoid and sphenoid sinuses. Jules Hardy saw it on his stint in Europe and devoted quite a bit of time making it very popular all over the world. Victor Horseley described subfrontal intracranial approach to pituitary. Whether large suprasellar , paresellar and retrosellar should also be approached from below is a matter of debate.Careful visualisation of sphenoid sinus, the intercarotid distance and whether suprasellar extension is in alignment of your approach will decide how much tumour you can remove from below. The extended approach to skull base tumours is also another issue which needs debate. If a general surgeon can remove appendix from intraluminal approach has strengthened the basis for endoscopic transnasal route to sellar tumours and other surronding pathologies. Just enlarging the sphenoid osteum and excision of microadenomas of pituitary is the best approach. The hard fact that reconstution of sellar floor to its previous anatomy should be re-emphasised. Instead of fascia lata fat has higher chance of survival( say from subcutaneous abdominal fat) is very ideal for reconstruction since fat needs very little vascularity, whereas muscle tends to shrink with time. M.Samii is great promoter of this concept. Glue can give you that much extrasecurity. Fat can however interfere in your assesment of residual and recurrent tumour since it is bright on both T1 and T2 weighted images. Anterior cranial fossa meningiomas can be very easily removed from intracranial approaches with very little blood loss and you do not have to spend time to reconstruct skull base as you have to do with approaches from below. Charlie Teo from Sydney is a bright neurosurgeon who has shown beautiful videos of these skull base tumours removed from below.
Neurosurgeon in group photograph from italy
written by sharmakchand, March 12, 2010
Thomas thanks for posting this group photograph. It shall be great if you could write about each person in group photograph briefly. it can become some sort of historical collection in future, like the one where Cushing is playing a tennis match with Dandy. All surgeons are wearing nice clothes and are well fed signifying that each one of them is quite prosperous. You can associate with me in enlisting all the neurosurgeons of the world countrywise with their emails, photographs . I think that can also become a sort of great document and can be updated every six months. Besides if the global population is 6 billion and let us say there are 4 neurosurgeons per million noumber will be only 24,000 which is not a big population. 1/6 This data can be collected by nominating one person per country and should not take more than 2 weeks. Also professionally qualified neurosurgeons should be made premium members of neurosurgic.com and others should remain just members. Since your site is free for everyone no body is likely to object being listed. The opportunities by becoming members can be enormous. Contributions to your site can become a part of scientific literature beacuse over a period of time truth wil stand out. Lot of neurosurgeons can be recognised this way because in scientific meeting only few stand out people make speeches everywhere. Anyway they also serve who just wait and watch.

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11 March 2010 Author: Thomas S
Thomas S
Tag: Skullbase surgery , Courses and Conferences
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