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Skull Base Brain Tumor Research

Winter 1999 Update
By Reza Jarrahy, M.D.

Current Research at the Skull Base Institute

Research at the Skull Base Institute since I came on board in July can be summarized primarily by three words: diverse, integrated, and active. The diversity of the research projects we are currently involved in reflects the diversity of the field of skull base surgery itself. From our basic science experiments to our clinical trials, the work we are doing in the lab is inherently linked to the surgical therapies we are currently offering our patients and those we are developing for the future.

The diversity of the research projects we are currently involved in reflects the diversity of the field of skull base surgery itself.

Our work with the pituitary gland is exemplary of how integrated our laboratory and operating rooms are. We have been hard at work trying to develop teaching models and innovative instruments geared toward performing endoscopic pituitary surgery. Since our last issue we have begun to use endoscopes to document the surgical anatomy of the anterior skull base and sella turcica in pigs. We have used cutting edge medical technology to image previously uncharted territory; we have in fact received requests from academic centers worldwide for more information in this exciting field of investigative surgery. Papers describing our surgical techniques and the images we have captured have already been submitted for publication. A revolution in the way pituitary surgery is learned and performed is upon us.

Our experience in the research institute has facilitated the application of endo-scopic pituitary surgery in humans. (see case of the month).

Our focus on the pituitary gland and pituitary diseases has not been limited to clinical projects. As you recall, as a precur.sor to developing a human model for pituitary transplant, we have taken a human pituitary cell suspension and injected it into rodents. Incredibly, these rodents demonstrated detectable levels of human pituitary hormone in their blood. Such results have never been documented. We plan to present these results at the annual meeting of the North American Skull Base Society next year. I have already designed a study to build upon the results of this pilot that should already be underway by the time this issue goes to press. More results to follow...

Our additional research efforts emphasize the varied anatomical areas that define the realm of the skull base surgeon. Drawing upon our experience with endoscopy in the sella turcica and challenged by the optical limitations of the operative microscope, we have successfully experimented with the use of the endoscope in the posterior fossa. There we have used it to assist in microvascular decompression of the trigeminal and facial nerves and in the resection of acoustic neuromas. Our observations thus far are that the endoscope provides a per-spective that we have found to be far superior to microscopy in looking around anatomic corners and obstacles that currently limit the exposure offered under the microscope. As in the pituitary surgery model, we are developing the pig as a training and educational model via journal article submissions to the investigative surgery community.

For all of our projects focusing on the intracranial aspects of skull base surgery, we have not forgotten the intimate association between the craniofacial skeleton and the base of the skull. Several projects that Dr. Shahinian and I worked on together in New York are still active, with papers currently in submission and more near com-pletion. Our recently published work on craniosynostosis complements our ongoing work with models for fetal craniofacial healing in the sheep model. Stay tuned: there's much going on and much more to report in the coming months.