Part of the Department of Neurosurgery,
the skull-base division began building its reputation in the 1980s and
earned national recognition for clinical excellence and research into
technical challenges posed by tumors deep in the brain.
During the last 10 years the specialty
has experienced a surge of interest and has adopted new techniques to
treat often barely accessible tumors.
Director of the division, Philip
Theodosopoulos, MD, an assistant professor in the College of Medicine,
says today's younger surgeons focus less on whether they can treat the
slow-growing and supposedly benign skull-base tumors that were
inoperable 10 to 15 years ago. Instead, they ask whether they can treat
them more safely and with fewer side effects.
"An enduring problem," Dr. Theodosopoulos
explains, "is that skull-base tumors are often lodged in deep holes and
difficult to see. In theory the operative microscope, with all its
refinements, has helped tremendously. Technological advancement has
helped as well.
"But there still remains the deep hole inside the brain--inaccessible and remote."
So today's neurosurgeons are adopting
"minimally invasive" approaches, special instruments to peer around
corners that were not previously navigable, and highly focused beams of
Chemotherapy also appears promising for
treating out-of-reach tumors, Dr. Theodosopoulos says, although its
implications in skull-base surgery have not been thoroughly researched.
"This is because it was assumed that
skull-base tumors are benign and don't require chemotherapy, and
because no institution has had enough patients to do a significant,
long-term study," Dr. Theodosopoulos says. "UC and University
Hospital's Neuroscience Institute clearly has enough patients, so we
plan to pursue this research.
"There is so much that we can do. But
whether we should do something and risk the consequences is always the
dilemma, because skull-base tumors grow slowly and, unlike other types
of brain tumors, are not imminently fatal."
If not removed, or only partially
removed, Dr. Theodosopoulos explains, skull-base tumors can influence
life expectancy, lifestyle and the ability to live a functional life.
On the other hand, removing these tumors completely can have
significant side effects.
"The trade-off compels us to strive for
better understanding of these tumors and the impact of treatments on
our patients," Dr. Theodosopoulos says. "There's so much more to learn."
Also responsible for training surgical
residents in the skull-base program, Dr. Theodosopoulos says it's time
to take neurosurgical education "to a bold new level."
Although cadaver dissection has served
neurosurgical education well, and will never be obsolete, Dr.
Theodosopoulos says, dissection labs as we know them will be replaced
by an exciting new technology--virtual surgery--as computer animation
becomes part of the education of young surgeons. Electronically
simulating, real-life surgical situations will enable residents to
learn first-hand what can and cannot be done safely.
Dr. Theodosopoulos says he plans to
develop the skull-base lab into a facility that will set 21st-century
teaching standards for neurosurgeons around the world.