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June 2010 Issue

Lee Zimmer, MD, PhD, of otolaryngology–head and neck surgery, and Philip Theodosopoulos, MD, of neurosurgery, are partnering to expand the possibilities of endoscopic surgery in treating skull base brain tumors.
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Specialties Partner to Grow Skull Base Surgery Practice

By Katy Cosse
Published June 2010

With a developing partnership between their departments, two UC surgeons are expanding the practice of skull base surgery.

For four years, Lee Zimmer, MD, PhD, assistant professor of otolaryngology–head and neck surgery, and Philip Theodosopoulos, MD, associate professor of neurosurgery, have pursued new surgical methods to reach difficult tumors at the skull base via an endoscopic approach through the nasal cavity and sinuses.

Part of the drive for their work came from Zimmer’s training at the University of Pittsburgh endoscopic cranial base program.

When he wanted to bring a pioneering new field to his work at UC, he decided to pursue it with a deliberate method.

Working with professors of neurosurgery John Tew, MD, and Mario Zuccarello, MD, Zimmer and Theodosopoulos first worked on expanding the pituitary sur-gery program by offering a purely endoscopic approach.

Now, the program has become the busiest pituitary program in the Midwest.

"We want to advance this field in a very stepwise, logical manner,” says Zimmer.

"When you want to go outside of a safe area, you form a team with your neurosurgeons, and over time, increase the complexity of surgery. You don’t want to take on complex tumors of the skull base without forming a solid team and without a solid anatomical understanding.”

In their latest innovation, they removed a skull base cyst via a minimally invasive approach through the sphenoid sinus.

Instead of the traditional approach, which requires large incisions behind the ear and dissection around the cochlea and carotid artery, Zimmer and Theodo-sopoulos used endoscopic tools to access the tumor via the nasal cavity and sinuses.

There, they were able to drain the cyst and create a drainage window into the sinus.

"From the standpoint of surgical complexity and post-op recovery, this is a much cleaner method of accessing these skull base cysts,” says Zimmer.

"There are a lot of different ways to use the procedure. What we’re trying to figure out is how many different ways can we access this region through the sinuses.”

To do so, they are utilizing a state-of-the-art skull base lab at UC, working to understand the endoscopic anatomy of the skull base and practice surgical approaches in cadavers before getting into the operating room.

They’ve also shared their work with several neurosurgery and otolaryngology journals in the past two years.

"Where, in the past, people have said, ‘You can access the sinuses, but you can’t go through them,’ we’ve pretty much put that to rest,” says Zimmer.

"You can go through the sinuses; you just need to understand the anatomy.”

To learn more, call the UC Neuroscience Institute at (866) 941-8264.

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