Future Course Dates:

March 14-17, 2012 (SOLD-OUT)
Guest Faculty: Charlie Teo, MD; Richard Harvey, MD

September 26-29, 2012
Guest Faculty: Albert Rhoton Jr., MD; Gustavo Nogueira, MD

November 14-16, 2012
Guest Faculty: Rodney Schlosser, MD; W. Alex Vandergrift, MD

November 17, 2012
25th Anniversary of the UPMC Center for Cranial Base Surgery One-Day Scientific Program
Guests of Honor: Laligam N. Sekhar, MD; Ivo P. Janecka, MD, MBA, PhD
Honorees: Joseph C. Maroon, MD; Eugene N. Myers, MD

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.

This course is a presentation of minimally invasive techniques for endoscopic endonasal surgery of the pituitary fossa and cranial base. Experts on the subject will present the anatomical and technical aspects of this procedure along with risks, benefits and outcomes. The course features live surgical demonstrations, didactic lectures, 3D stereoscopic surgical anatomy lectures, and hands-on dissection on high-quality injected heads.

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:

• Review 3D anatomic relationships of the sinonasal cavity, pituitary fossa, and ventral skull base.
• Describe minimally invasive approaches for endoscopic surgery of the cranial base and pituitary fossa.
• Identify methods to avoid and manage major complications of endoscopic surgery of the cranial base and pituitary fossa.

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 three 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 Brain Surgery Center.

Meeting Location
Course Directors and Other Faculty
Continuing Education Credit
Tentative Course Schedule
Cadaveric Dissection/Prosection Schedule
Registration Fee
Cancellation Policy
Hotel Accommodations
Suggested Reading
Contact Us
What Other Participants Are Saying

Meeting Location

All lectures are held in the Neurosurgical Center for Education which is located in UPMC Presbyterian Hospital on the 4th Floor of the B Wing within Suite 400.

All lab sessions are held in the Teaching Lab which is located in Scaife Hall of the University of Pittsburgh School of Medicine on the 3rd Floor within Suite 351.

(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.

Course Directors and Other Faculty

• Course Directors:

Carl H. Snyderman, MD, MBA
Professor
Departments of Otolaryngology and Neurological Surgery
University of Pittsburgh School of Medicine
Co-Director, Center for Skull Base Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA

Paul Gardner, MD
Assistant Professor
Department of Neurological Surgery
University of Pittsburgh School of Medicine
Co-Director, Center for Skull Base Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA

Juan Fernandez-Miranda, MD
Assistant Professor of Neurological Surgery
Department of Neurological Surgery
Director, Surgical Neuroanatomy Lab
University of Pittsburgh School of Medicine
Pittsburgh, PA

• Course Faculty:

S. Tonya Stefko, MD
Assistant Professor
Departments of Ophthalmology and Neurological Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA

Elizabeth C. Tyler-Kabara, MD, PhD
Assistant Professor
Department of Neurological Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA
 
Eric W. Wang, MD
Assistant Professor
Department of Otolaryngology
University of Pittsburgh School of Medicine
Pittsburgh, PA

Continuing Education Credit

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.

Tentative Course Schedule

Day 1

7:15 – 8:45 a.m.
Registration, Breakfast, Welcome, Course Overview

8:45 a.m. – 11:45 p.m.
Lectures

• Level I and II Approaches
• Endoneurosurgery Suite, Equipment, Instrumentation
• Endoscopic Pituitary Surgery

11:30 a.m. - 12:30 a.m.
Lunch & Lectures

• Reconstruction of Dural Defects
• Laboratory Safety: Blood Borne Pathogen Training

12:30 - 2:30 p.m.
Lab Session 1

• Anatomical Dissection: Intraoperative Navigational Device; Intranasal Landmarks; Middle Turbinates; Septal Mucosal Flap; Sphenoidotomy; Sella
• 3D Endoscopic Skull Base Anatomy: Sellar and Parasellar Regions
• Anatomical Prosection: Level I and II Procedures – Sagittal Plane
• Phacon Training Models

2:30 - 3:00 p.m.
Lecture

• Craniofacial Resection of Sinonasal Malignancy: Principles and Outcomes

3:00 - 5:00 p.m.
Lab Session 2

• Anatomical Dissection: Intraoperative Navigational Device; Intranasal Landmarks; Middle Turbinates; Septal Mucosal Flap; Sphenoidotomy; Sella
• 3D Endoscopic Skull Base Anatomy: Sellar and Parasellar Regions
• Anatomical Prosection: Level I and II Procedures – Sagittal Plane
• Phacon Training Models

6:00 – 8:30 p.m.
Reception, Dinner, Guest Faculty Lectures

8:30 p.m.
Adjournment

Day 2

7:30 – 8:00 a.m
Breakfast

8:00 - 8:30 a.m.
Lecture
• Sagittal Plane Modules I: Pituitary, Transplanum, and Transcribriform

8:30 - 11:30 a.m.
Case Presentations & Live Surgery Demonstration

11:30 a.m. - 12:30 p.m.
Lunch & Lecture

12:30 - 2:30 p.m.
Lab Session 3

• Anatomical Dissection: Suprasellar/Transplanum Approach; Ethmoidectomy; Medial Orbital Decompression; Optic Nerve Decompression; Ethmoid Artery Ligation; Frontal Sinusotomy (Draf 3 Procedure); Craniofacial Resection
• 3D Endoscopic Skull Base Anatomy: Anterior Skull Base
• Anatomical Prosection: Approaches to the Anterior Skull Base
• Phacon Training Models

2:30 - 3:30 p.m.
Lecture

• Sagittal Plane Modules II: Transclival, Transodontoid

3:30 - 5:30 p.m.
Lab Session 4

• Anatomical Dissection: Suprasellar/Transplanum Approach; Ethmoidectomy; Medial Orbital Decompression; Optic Nerve Decompression; Ethmoid Artery Ligation; Frontal Sinusotomy (Draf 3 Procedure); Craniofacial Resection
• 3D Endoscopic Skull Base Anatomy: Anterior Skull Base
• Anatomical Prosection: Approaches to the Anterior Skull Base
• Phacon Training Models

5:30 p.m.
Adjournment. Evening at Leisure

Day 3

7:30 – 8:00 a.m.
Breakfast

8:00 a.m. - 8:45 a.m.
Lecture

• Coronal Plane I: Transpterygoid Approach

8:45 a.m. - 12:00 p.m.
Lab Session 5

• Anatomical Dissection: Pituitary Transposition; Transclival Approach (Extradural/Intradural); Transodontoid Approach; Medial Transpetrous Approach; Cavernous Sinus Approaches; Transorbital Approach
• 3D Endoscopic Skull Base Anatomy: Posterior and Middle Skull Base
• Anatomical Prosection: Approaches to the Posterior Skull Base
• Phacon Training Models

12:00 - 1:15 p.m.
Lunch & Lecture

• Coronal Plane II

1:15 - 4:15 p.m.
Lab Session 6

• Anatomical Dissection: Pituitary Transposition; Transclival Approach (Extradural/Intradural); Transodontoid Approach; Medial Transpetrous Approach; Cavernous Sinus Approaches; Transorbital Approach
• 3D Endoscopic Skull Base Anatomy: Posterior and Middle Skull Base
• Anatomical Prosection: Approaches to the Posterior Skull Base
• Phacon Training Models

4:15 p.m.
Adjournment

6:00 - 9:30 p.m.
Course Banquet

Day 4

7:45 – 9:15 a.m.
Breakfast & Lectures

• Endoscopic Endonasal Surgery in the Pediatric Population
• Choosing the Best Approach: Multicorridor Surgery

9:15 - 11:45 a.m.
Lab Session 7

• Anatomical Dissection: Maxillary Antrostomy; Sphenopalatine Artery Ligation; Middle Cranial Fossa Approaches – Suprapetrous; Masticator Space; Infrapetrous Approach; Parapharyngeal Space; Infratemporal Skull Base
• Special Anatomical Prosection: Orbital Approaches
• Anatomical Prosection: Approaches to the Middle Skull Base; Pericranial Flap
• Phacon Training Models

11:45 AM - 1:15 p.m.
Lunch & Lecture

• Prevention and Management of Complications

1:15 - 3:45 p.m.
Lab Session 8

• Anatomical Dissection: Maxillary Antrostomy; Sphenopalatine Artery Ligation; Middle Cranial Fossa Approaches – Suprapetrous; Masticator Space; Infrapetrous Approach; Parapharyngeal Space; Infratemporal Skull Base
• Special Anatomical Prosection: Orbital Approaches
• Anatomical Prosection: Approaches to the Middle Skull Base; Pericranial Flap
• Phacon Training Models

3:45 p.m.
Course concludes

Cadaveric Dissection/Prosection Schedule

Day 1

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. 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.

5. 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. 

6. 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.

Day 2

1. 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. 

2. 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.

3. Sphenopalatine artery ligation.  Expose the sphenopalatine and posterior nasal arteries and transect them.

4. 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. 

5. 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.

6. Anterior and posterior ethmoid artery ligation.  Elevate the periorbita along the skull base and identify the anterior and posterior ethmoid arteries.

7. 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.

8. 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.

Day 3

1. Posterior clinoids. Lift up the pituitary gland and drill out the posterior clinoids.

2. Transclival approach (extradural).  Remove the bone of the clivus to expose the dura from the sphenoid to the mid-clivus.

3. Transclival approach (intradural).  Open the dura to expose the vertebral and basilar arteries.

4. 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.

5. Reconstruction with mucosal flap.  Position mucosal flap in different areas of the skull base to see limits of reach and surface area of reconstruction.

6. Transorbital approach.  Incise periorbita and identify medial rectus muscle.  Dissect between medial and inferior rectus muscles and identify orbital apex structures.

7. 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.

Day 4

1. Perform a middle meata maxillary antrostomy on each side.  Remove the uncinate process and enlarge the opening posteriorly and inferiorly.  Make sure that you preserve the sphenopalatine arteries.

2. 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.

3. 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.

4. Middle cranial 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.

5. Lateral cavernous sinus.  Dissect superior to Meckel’s cave, lateral to the ICA.  Identify the contents of the cavernous sinus.

6. 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.

7. Infrapetrous approach.  Transect V3 and drill the bone along the inferior aspect of the petrous bone to expose the petrous ICA.

8. Pericranial flap. Make a bicoronal scalp incision and elevate the scalp deep to the level of the superior orbital rims. Expose the nasion and drill a 1x2 cm opening into the nasal cavity. Elevate a pericranial flap based on one or both supraorbital arteries. Pass the flap into the nasal cavity and reconstruct the dural defect.

9. [your name here] approach. Discover a new approach to the cranial base and put your name on it.

Registration Fee

Space is limited! Registrations will be accepted in the order received. Please do not make travel arrangements until you have received an official acceptance letter.

Full Course Registration:

CME credit, course materials, lectures, hands-on cadaver dissection, and all meals.

$3,000 Single Registrant (1 cadaver head x 1 registrant)

$5,000 Team Registration (1 cadaver head x 2 registrants)

Observer Registration Includes:

CME credit, course materials, lectures, and all meals, $1,000.

Reduced registration fees are available for residents and fellows.

To register, please contact:

Mary Jo Tutchko, Conference Manager
Center for Cranial Base Surgery
Department of Otolaryngology
UPMC/University of Pittsburgh Medical Center
200 Lothrop Street, EEI 500
Pittsburgh PA 15213
Phone: (412) 647-8186
Fax: (412) 647-2080
E-mail: tutchkomj@upmc.edu

Cancellation Policy

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
Center for Cranial Base Surgery
Department of Otolaryngology
UPMC/University of Pittsburgh Medical Center
200 Lothrop Street, EEI 500
Pittsburgh PA 15213
Phone: (412) 647-8186
Fax: (412) 647-2080
E-mail: tutchkomj@upmc.edu

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.

Hotel Accommodations

A block of rooms has been reserved at the...

Holiday Inn Select, Pittsburgh University Center
100 Lytton Avenue
Pittsburgh, PA 15213
Phone: (412) 682-6200

To book online, visit www.hiselect.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 UPMC Presbyterian are:

Hilton Garden Inn
3454 Forbes Avenue
Pittsburgh PA 15213
Phone: (412) 683-2040

Hampton Inn University Center
3315 Hamlet Street
Pittsburgh, PA 15213
Phone: (412) 681-1000

Quality Inn University Center
3401 Boulevard of the Allies
Pittsburgh, PA 15213
Phone: (412) 683-6100

Suggested Reading

Because this is an advanced course, please find below a list of publications that you are strongly encouraged to review prior to the course.

1. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL: Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005 Jul 15;19(1):E3.
2. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL: Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005 Jul 15;19(1):E4.
3. Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R: Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005 Jul 15;19(1):E6.
4. Kassam A, Snyderman CH, Carrau RL, Gardner P, Mintz A: Endoneurosurgical hemostasis techniques:  lessons learned from 400 cases. Neurosurg Focus. 2005 Jul 15;19(1):E7.
5. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A.  A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap.  Laryngoscope.  2006 Oct;116(10):1882-6.
6. Snyderman CH, Kassam AB, Carrau R, Mintz A:  Endoscopic approaches to the petrous apex.  Operative Techniques in Otolaryngology.  2006;17:168-73.
7. Snyderman C, Kassam A, Carrau R, Mintz AH, Gardner P, Prevedello DM:  Acquisition of surgical skills for endonasal skull base surgery: a training program.  Laryngoscope  2007 Apr;117(4):699-705.
8. Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R.  Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern.  Neurosurgery. 2008 Mar;62(3 Suppl):57-72; discussion 72-4.
9. Gardner PA, Prevedello DM, Kassam AB, Snyderman CH, Carrau RL, Mintz AH.  The evolution of the endonasal approach for craniopharyngiomas.  J Neurosurg. 2008 May;108(5):1043-7.
10. Snyderman CH, Carrau RL, Kassam AB, Zanation A, Prevedello D, Gardner P, Mintz A.  Endoscopic skull base surgery: principles of endonasal oncological surgery.  J Surg Oncol. 2008 Jun;97(8):658-64. 
11. Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB.  Endoscopic endonasal surgery for petrous apex lesions.  Laryngoscope. 2009 Jan;119(1):19-25.
12. Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB.  Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery.  Am J Rhinol Allergy.  2009 Sep-Oct;23(5):518-21. 
13. Patel MR, Shah RN, Snyderman CH, Carrau RL, Germanwala AV, Kassam AB, Zanation AM.  Pericranial flap for endoscopic anterior skull-base reconstruction: clinical outcomes and radioanatomic analysis of preoperative planning.  Neurosurgery.  2010 Mar;66(3):506-12; discussion 512.
14. Morera VA, Fernandez-Miranda JC, Prevedello DM, Madhok R, Barges-Coll J, Gardner P, Carrau R, Snyderman CH, Rhoton AL Jr, Kassam AB.  “Far-medial” expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches.  Neurosurgery.  2010 Jun;66(6 Suppl Operative):211-9, discussion 219-20.
15. Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, Gardner P, Morera V, Madhok R, Carrau RL, Snyderman CH, Rhoton AL Jr, Kassam AB.  Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies.  Neurosurgery. 2010 Jul;67(1):144-54, discussion 154.
16. Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Strojan P, Suarez C, Genden EM, Rinaldo A, Ferlito A.  Craniopharyngioma: a pathologic, clinical and surgical review.  Head Neck.  2011 May 16 (Epub ahead of print). 

Contact Us

For additional information, please contact:

Mary Jo Tutchko, Conference Manager
Center for Cranial Base Surgery
Department of Otolaryngology
UPMC/University of Pittsburgh Medical Center
200 Lothrop Street, EEI 500
Pittsburgh PA 15213
Phone: (412) 647-8186
Fax: (412) 647-2080
E-Mail: tutchkomj@upmc.edu

What Other Participants Are Saying

Here’s what participants from our most recent course had to say:

• "Thank you! Outstanding course."
• "Excellent all the way."
• "The 3-D anatomy was great and so helpful!"
• "Excellent supervision during anatomical dissection."
• "All the faculty were available and helpful."
• "Good balance of ENT, neurosurgery information."
• "Best course I have ever taken! "