The Surgical Neuroanatomy Lab (SNL) has a dual educational and research role aiming to improve surgical techniques and outcomes by mastering knowledge of relevant surgical neuroanatomy. Under the joint direction of Paul Gardner, MD, and George Zenonos, MD, in the Department of Neurological Surgery, and Carl Snyderman, MD, MBA, and Eric Wang, MD, in the Department of Otolaryngology, the lab follows our clinical philosophies of teamwork and innovation.
Many national and international students, residents, and fellows have conducted training and research at the SNL during the last years. The working philosophy at the SNL is that of Albert L. Rhoton, Jr., MD, handed down from Juan Fernandez-Miranda, MD: meticulous and exquisite anatomical microdissections to better understand the intricacies of the complex anatomy of the human brain and skull base.
The lab has four main research/educational areas: endoscopic skull base anatomy, microsurgical neuroanatomy, new approach development, and white matter anatomy/brain connectivity/surgical planning.
Endoscopic Skull Base Anatomy
The Endoscopic Endonasal Approach (EEA) has revolutionized skull base neurosurgery. The EEA has anatomical and technical advantages over open skull base approaches for the treatment of selected lesions. EEA is not minimally invasive but designed to be maximally effective for the treatment of a wide variety of ventral skull base lesions. The Surgical Neuroanatomy Laboratory at the University of Pittsburgh has pioneered anatomical work on the area of skull base endoscopy, and its goal is to continue providing landmark contributions to the skull base community. Meticulous knowledge of the ventral skull base anatomy as seen from the endoscopic perspective is critical to apply endonasal endoscopic surgery in an effective and safe manner.
Conventional skull base approaches are being compared with novel endoscopic endonasal approaches to aid in understanding indications and limitations of different but complementary skull base approaches. Contemporary skull base surgeons should combine expertise in open and endoscopic skull base approaches to select the most appropriate approach and technique for each particular case. Emphasis is made on the circumferential conceptualization of the skull base and the selection of “anatomically-favorable” surgical routes.
New Approach Development
Following our philosophy of constant evaluation and innovation between the anatomy lab and the operating room, the SNL is used to develop and examine new approaches or expand known approaches to help define modern skull base surgery. Examples include the expansion of the lateral orbitotomy to the cavernous sinus and middle fossa and the development of the contralateral transmaxillary (CTM) approach.
White Matter Anatomy
Dissection of the white matter fiber tracts provides a unique insight into the complex intrinsic architecture of the brain and builds up an essential knowledge for operating on intra-axial tumors. A unique feature of our white matter studies is the combination with advanced imaging techniques, such as High-Definition Fiber Tractography (HDFT), to facilitate greater understanding of brain connectivity “in-vivo” and in neurosurgery patients. These techniques are also being studied to try to improve the imaging of cranial nerves.