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January 2005 Issue

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Skull-Base Program Introduces Latest Techniques

Published January 2005

UC is to revitalize its nationally renowned Division of Skull Base Surgery by introducing new treatments and pioneering "virtual surgery" as a teaching tool.

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 radiation.

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.

"We have the foundation, talent and technical expertise to accomplish this goal," he says.

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