Clinical Briefing: Innovative Center for the Treatment of Complex
Skull-Base Disorders
March / April 2006
The Center
for Cranial Base Surgery at the University of
Pennsylvania Health System (UPHS) employs innovative,
nerve-sparing endoscopic surgery procedures for the treatment
of a variety of complex skull-base disorders. Minimally invasive
craniotomy decreases brain-related complications and reduces
or eliminates other functional and cosmetic disfigurements.
Previously inaccessible tumors can now be successfully
treated with the combination of advanced neurodiagnostic
imaging and a variety of radio- and micro-surgical techniques.
Neuroradiologic mapping produces highly precise clinical
imaging of advanced tumors within the central and peripheral
nervous system; interventional angiography defines critical
vascular structure and decreases blood loss during certain
procedures; cranial nerve monitoring during surgery identifies
and preserves vision, hearing, balance, and facial expressions
as well as speech and swallowing; restorative and reconstructive
facial and skull base surgery reduces opportunity for disfigurement;
and intraoperative computer-assisted navigation identifies
the precise location of tumors in relation to surrounding
vital tissues.
In addition to its program of neurocritical
care and multimodality monitoring, the Center provides
fully equipped rehabilitation services and programs.
Case Study
Ms. B. is a 27-year-old woman who presented
with chronic congestion and nosebleeds on the right side
of her nose. Upon examination, a mass was observed on the
right side, and a subsequent biopsy revealed an olfactory
neuroblastoma. Review of the pre-operative images indicated
that the tumor had invaded the skull base on only one side,
raising the possibility that the olfactory nerve on the opposite
side could be spared, preserving the sense of smell.
The surgical approach to achieve this type of resection
required visualization of structures immediately behind the
frontal air sinus. The team removed the bone over the sinus,
then, going through the sinus, removed the bone needed to
see the origin of the two olfactory nerves. The affected
side was removed with the surrounding dura, preserving the
unaffected side that was immediately adjacent. Importantly,
the dura was reconstructed to prevent a spinal fluid leak
through the nose after surgery, and the skull reconstructed
to provide an excellent cosmetic appearance in a very visible
area just above the eyes.
Ms. B. suffered no sensory dysfunction post-operatively.
She was discharged to home after five days for further convalescence.
Today, she is at her pre-illness state of health and is followed
for routine evaluations at the Center for Cranial Base Surgery
at UPHS.
Our Team
Given the complexity of many cranial base
disorders, The Center for Cranial Base Surgery at UPHS uses
a multidisciplinary approach, combining the expertise of
Penn specialists in otorhinolaryngology - head and neck surgery,
neurosurgery, neuroradiology, radiation oncology, oncology,
and The Center for Head and Neck Cancer.
Co-Directors
M. Sean Grady, MD
Charles Harrison Frazier Professor and Chair Department
of Neurosurgery
Bert W. O'Malley, Jr., MD
Gabriel Tucker Professor and Chair
Department of Otorhinolaryngology - Head & Neck Surgery
Neurosurgery
Kevin D. Judy, MD
Peter D. LeRoux, MD, FACS
Donald M. O'Rourke, MD
Otorhinolaryngology - Head & Neck Surgery
Douglas Bigelow, MD
David W. Kennedy, MD
Jason Newman, MD
James N. Palmer, MD
Michael J. Ruckenstein, MD
Gregory S.Weinstein, MD, FACS
Radiation Oncology
Robert
Lustig, MD
Harry Quon, MD, MS
Jeffrey G. Rosenstock, MD
Plastic and Reconstructive Surgery
Joseph M. Serletti, MD
Ara A. Chalian, MD
Hematology-Oncology
Eric J. Sherman, MD
Interventional Neuroradiology
Robert W. Hurst, MD
Laurie A. Loevner, MD
Elias R Melhem, MD
Access
Patient appointments are available at:
Department of Neurosurgery
Hospital of the University
of Pennsylvania
3400 Spruce Street
3rd Floor, Silverstein Building
Philadelphia, PA 19104
Department of Otorhinolaryngology - Head & Neck
Surgery
Hospital of the University of Pennsylvania
3400
Spruce Street
5th Floor, Silverstein Building
Philadelphia, PA 19104
Department of Neurosurgery
Pennsylvania Hospital
330 South 9th Street
Philadelphia, PA 19107
Department of Otorhinolaryngology - Head & Neck
Surgery
Pennsylvania Hospital
811 Spruce Street
Philadelphia, PA 19107
To refer a patient and/or
consult with a doctor:
Please contact your UPHS physician liaison with
any concerns or problems you may experience when referring
your patient.
Penn Neurosurgery is a part of the Penn Neurological
Institute.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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