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UPMC Center for Cranial Base Surgery Celebrates 25th Anniversary

Scientific Symposium Honors Surgical Pioneers

PITTSBURGH, Nov. 16, 2012 – Twenty-five years ago at what is now UPMC Presbyterian, a neurosurgeon and a head and neck surgeon began routinely taking radical routes – primarily through the scalp and face – to remove deadly tumors and other lesions on the underside of the brain that could not be reached by conventional surgery through the skull.
Before and since its formal inception in 1987, experts at the UPMC Center for Cranial Base Surgery have continued to lead the field of minimally invasive brain surgery by developing new techniques, tools and procedures that have made it possible to get to masses, some the size of baseballs, and take them out through a nostril, said Center co-director Carl Snyderman, M.D., professor, Department of Otolaryngology, University of Pittsburgh School of Medicine.
“I was the first training fellow in the Center, and it was the first of its kind in North America,” he said. “The Center’s founders really were pioneers, doing something no one else was doing. The marathon procedures – one was 36 hours long – were very radical, risky, and deviated from the standard of care, so they were met with lots of resistance. Now, some of the techniques they championed are routine and widespread.”
Aggressive surgeries that required deconstruction followed by reassembly of the bones and tissue of the face evolved with advances in imaging and surgical optics, making it possible to perform operations through smaller incisions. Radiosurgery techniques, such as the Gamma Knife, added to the arsenal of treatments for tumors that once were considered inoperable. 
Since 1997, more than 2,000 endonasal surgeries have been performed in adults and children. In a study published in the September issue of Neurosurgery, UPMC surgeons reviewed 60 operations performed between April 2003 and March 2011 to remove chordomas - a kind of slow-growing, malignant tumor that typically arises in challenging locations - using an endoscopic endonasal approach (EEA,) in which an endoscopic instrument is guided through a nostril to reach the bottom of the brain. More than two-thirds were completely excised, a rate that improved to nearly 90 percent in the later years of that period.
“This tells us that EEA is a solid alternative to conventional techniques that often lead to significant surgical complications, such as nerve injury,” said study co-author Paul A. Gardner, M.D., assistant professor, Department of Neurological Surgery, and co-director of the UPMC Center for Cranial Base Surgery. “During the last decade, these minimally invasive approaches have been gaining ground as we learn better ways to apply them.”
In celebration of the 25th anniversary, a scientific symposium will be held on Saturday, Nov. 17 at the Thomas E. Starzl Biomedical Science Tower in Oakland to discuss current practices and the future of the field. It also will honor those who developed the revolutionary operations, including UPMC Center for Cranial Base Surgery founding directors head and neck surgeon  Ivo P. Janecka, M.D., M.B.A., Ph.D., now director of  the Foundation for Systems Research and Education in New York, and neurosurgeon Laligam N. Sekhar, M.D., now William Joseph Leedom and Bennett Bigelow Professor of Neurological Surgery at the University of Washington; as well as the University of Pittsburgh School of Medicine’s Joseph C. Maroon, M.D., Heindl Scholar in Neuroscience and clinical professor of neurological surgery, and Eugene N. Myers, M.D., Distinguished Professor and emeritus chair of otolaryngology, who together in 1974 performed the medical center’s first cranial base surgery by removing a sinus tumor through the face.
“To be successful, cranial base surgery has required collaboration between neurosurgeons, head-and-neck surgeons, plastic surgeons, radiologists and many other medical experts,” Dr. Snyderman noted. “We’ve learned that we can’t get comfortable with doing things one way. We have to challenge ourselves and be receptive to new ideas.”
Center experts have taught a specialized anatomy and surgical techniques course to more than 1,000 surgeons from 50 countries since 2003 and now train 30 visiting scholars and four clinical fellows annually. The Eye & Ear Foundation recently received a $50,000 gift from the Sumner M. Redstone Charitable Foundation, which will help fund a surgical simulation training center that will teach endonasal surgeons from around the world the latest cranial base techniques.

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