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Minimally Invasive Endoscopic Surgery of the Cranial Base and Pituitary Fossa Course |
2009 Course Dates: January 14-17 (Hurry! Only four openings remain) December 2-5 This course is a presentation of minimally invasive techniques for endoscopic surgery of the cranial base and pituitary fossa. Experts on the subject will present the technical aspects of this operation along with risks, benefits and outcomes. This course is designed for neurosurgeons, otolaryngologists-head and neck surgeons and minimally invasive skull base surgeons who are interested in the most recent developments in endoscopic surgery of the cranial base and pituitary fossa. The course features a live surgical demonstration, didactic lectures and hands-on cadaver dissection. Participants will have an opportunity to gain and expand their knowledge regarding endoscopic surgery of the cranial base and pituitary fossa using minimally invasive techniques. Following completion of this program, participants should be able to:
Participation by all individuals is encouraged. Advance notification of any special needs will help us provide better service. Please notify us of your needs at least two weeks in advance of the program by calling (412) 647-6358.
This course is sponsored by the University of Pittsburgh School of Medicine Center for Continuing Education in the Health Sciences, the Department of Neurological Surgery, the Department of Otolaryngology, and the UPMC Minimally Invasive endoNeurosurgery Center.
Meeting Location Unless otherwise indicated, all activities will be held in the Biomedical Science Tower -- adjoining The Eye & Ear Institute -- located on Lothrop Street in the Oakland section of Pittsburgh. (See maps on our directions page for interactive maps and driving directions from any location in the United States and Canada.) Parking is available in the UPMC garage on Lothrop and Terrace Streets. Day 1 8:00 – 8:30 a.m. 8:30 a.m. – 12:00 p.m. General Principles, Anatomy, Equipment, and 12:00 – 1:00 p.m. 1:00 – 4:30 p.m. 6:00 – 9:00 p.m. Day 2 7:30 – 8:00 a.m 8:00 a.m. – 5:00 p.m. Nasoseptal Flap and Sellar and Suprasellar Day 3 7:30 – 8:00 a.m. 8:00 a.m. – 5:00 p.m. Sagittal Plane (Cribriform, Clival and Odontoid Approaches) 6:30 – 9:30 p.m. Day 4 7:30 – 8:00 a.m. 8:00 a.m – 3:00 p.m. Completion of Sagittal Plane and Coronal Plane 3:00 p.m. Cadaveric Dissection/Proection Schedule 1. Intraoperative navigational device. Familiarize yourself with the function of the image guidance system 2. Identify the following intranasal landmarks: inferior turbinate, middle turbinate, superior turbinate, middle meatus, hiatus semilunaris, uncinate process, bulla ethmoidalis, sphenoid rostrum, sphenoid ostium 3. Resect the middle turbinates. 4. Perform a middle meatal antrostomy on each side. Remove the uncinate process and enlarge the opening posteriorly and inferiorly. Make sure that you preserve the sphenopalatine arteries. 5. Ethmoidectomy. Open the bulla ethmoidalis and remove anterior ethmoid air cells in an anterior to posterior direction. Identify the lamina papyracea. Expose the nasofrontal recess and identify the anterior ethmoid artery. Repeat the ethmoidectomy on the opposite side. 6. Elevate a septal mucosal flap on one side. It should be pedicled on the ipsilateral posterior nasal artery. Displace the flap into the nasopharynx during the other procedures. 7. Endonasal approaches for pituitary surgery. Transect the posterior nasal septum and expose the sphenoid rostrum. Remove rostrum and open sphenoid air cells. Enlarge the opening maximally in all directions. Resect the posterior edge of the nasal septum to enhance bilateral exposure. Identify sphenoid sinus landmarks: planum sphenoidale, optic canal, lateral optic-carotid recess, carotid canal, medial optic-carotid recess, sella, clival recess. Remove sphenoid septations and note relationship to carotid canal. 8. Pituitary. Open the sella to the margins of the cavernous sinus in all directions. Remove sphenoid rostrum inferiorly and note how it improves access to the sella. 9. Sphenopalatine artery ligation. Expose the sphenopalatine and posterior nasal arteries and transect them. 10. Medial orbital decompression. Make an opening in the lamina papyracea and remove the medial orbital wall from the fovea ethmoidalis superiorly to the orbital floor and as far posteriorly as the anterior wall of the sphenoid sinus. 11. Optic nerve decompression. Decompress the orbital apex and follow the optic canal posteriorly. Use the drill to thin the bone over the optic nerve without exposing the carotid artery. 12. Suprasellar/ transplanum approach. Thin and remove the bone of the planum sphenoidale. Thin and remove the bone of the “tuberculum strut” bilaterally. Open the suprasellar dura and identify the optic chiasm, infundibulum, and ICA. 13. Anterior and posterior ethmoid artery ligation. Elevate the periorbita along the skull base and identify the anterior and posterior ethmoid arteries. 14. Frontal sinusotomy (Draf procedure). Perform a Draf Type 3 procedure. Resect the anterior nasal septum superiorly, anterior to the middle turbinates. Remove the floor of the frontal sinuses across the midline and anterior to the crista galli. 15. Anterior craniofacial resection. Resect the superior attachment of the nasal septum from the crista galli to the sphenoid. Resect attachments of middle turbinates. Thin and remove bone of anterior cranial base from ethmoid roof laterally and to planum sphenoidale posteriorly. Drill out crista galli. Incise dura bilaterally and then transect falx attachment anteriorly. Reflect dura posteriorly and identify olfactory bulbs. Elevate olfactory tracts and transect nerves posteriorly. Identify the interhemispheric fissures, frontopolar vessels, and anterior communicating artery. 16. Posterior clinoids. Lift up the pituitary gland and drill out the posterior clinoids. 17. Transclival approach (extradural). Remove the bone of the clivus to expose the dura from the sphenoid to the mid-clivus. 18. Transclival approach (intradural). Open the dura to expose the vertebral and basilar arteries. 19. Transodontoid approach. Remove the soft tissues between the Eustachian tubes to the level of the soft palate. Remove cortical bone of the clivus from the sphenoid floor to the foramen magnum. Remove the lower edge of the clivus (foramen magnum). Expose the ring of C1 and remove the central portion. Drill out the dens down to the level of the body of C2. 20. Reconstruction with mucosal flap. Position mucosal flap in different areas of the skull base to see limits of reach and surface area of reconstruction. 21. Medial petrous apex. Drill the bone medial and deep to the ICA at the level of the clival recess. Open air cells of the petrous apex. Identify the course of the 6th cranial nerve. 22. Transpterygoid approach. Transect the sphenopalatine and posterior nasal arteries and open the pterygopalatine space. Elevate the soft tissue to expose the bone of the base of the pterygoids. Identify the vidian artery and nerve. 23. Exposure of petrous ICA. Drill the bone inferior and medial to the vidian artery and follow the vidian artery to the 2nd genu of the internal carotid artery. 24. Middle fossa approach (suprapetrous). Identify V2 and drill the bone between V2 and the vidian artery to expose the petrous ICA. Open Meckel’s cave lateral to the vertical segment of the ICA. 25. Lateral cavernous sinus. Dissect superior to Meckel’s cave, lateral to the ICA. Identify the contents of the cavernous sinus. 26. Infratemporal skull base. Identify the medial and lateral pterygoid plates inferior to the base of the pterygoids. Follow the lateral pterygoid plate to foramen ovale and identify V3. Resect the medial portion of the Eustachian tube. Open the space between the pterygoid plates and dissect the medial and lateral pterygoid muscles. Follow the Eustachian tube along the skull base and identify the ICA where it enters the skull base. 27. Infrapetrous approach. Transect V3 and drill the bone along the inferior aspect of the petrous bone to expose the petrous ICA. 28. [your name here] approach. Discover a new approach to the cranial base and put your name on it.
Amin B. Kassam, MD Carl H. Snyderman, MD Ricardo L. Carrau, MD Paul Gardner, MD Daniel M. Prevedello, MD Faculty Disclosure In accordance with Accreditation Council for Continuing Medical Education requirements on disclosure, information about relationships of presenters with commercial interests (if any) will be included in materials distributed at the time of the conference. The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this educational activity for AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other healthcare professionals are awarded continuing education units (CEU's) which are equal to contact hours. Registration Fee and Information Space is limited! Registrations will be accepted in the order received. Please do not make travel arrangements until an acceptance letter has been received. Full Course Registration: (includes CME credit, course materials, lectures, hands-on cadaver dissection, and all meals) Observer Registration: (includes CME credit, course materials, lectures, and all meals) To register, please contact: Mary Jo Tutchko, Conference Manager All cancellations must be in writing and sent via US mail, e-mail or fax. Tuition for cancellations postmarked or date-stamped 60 days before the first day of the course will be completely refunded. No refunds will be made if notice received less than 60 days from the first day of the course. Cancellation requests should be sent to: Mary Jo Tutchko, Conference Manager The UPMC/Center for Continuing Education in the Health Sciences reserves the right to cancel this program if sufficient registrations are not received. In the case of cancellation, the department will fully refund registration fees. However, other costs incurred by the registrant, such as airline or hotel penalties, are the responsibility of the registrant. A block of rooms has been reserved at... Holiday Inn Select, University Center To book online, visit: www.holidayinn.com/pit-univctr. Go to the Check Availability box on the left, type in the desired dates, enter the group code MIS, click check availability, and book. Other hotels within walking distance of the Biomedical Science Tower are: Wyndham Garden Hotel, University Place Hampton Inn University Center Quality Inn University Center Center for Continuing Education in the Health Sciences The UPMC Center for Continuing Education in the Health Sciences invites you to visit our web location. Receive information on CME programs, earn CME credits on the Internet, and access information about our formal courses and much more. Discover who we are and how you can contact us. Please visit our web location often to get updated information on upcoming programs. The University of Pittsburgh, as an educational institution and as an employer, values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Accordingly, the University prohibits and will not engage in discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam era. Further, the University will continue to take affirmative steps to support and advance these values consistent with the University's mission. This policy applies to admissions, employment, access to and treatment in University programs and activities. This is a commitment made by the University and is in accordance with federal, state, and/or local laws and regulations. For information on University equal opportunity and affirmative action programs and complaint/grievance procedures, please contact: William A. Savage, Assistant to the Chancellor and Director of Affirmative Action (and Title IX and 504 Coordinator), Office of Affirmative Action, 901 William Pitt Union, University of Pittsburgh, Pittsburgh, PA 15260, (412) 648-7860. |
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