J Neurol Surg B Skull Base 2016; 77 - FP-16-02
DOI: 10.1055/s-0036-1592519

Extended Endoscopic Endonasal Approach to the Anterior and Central Skull Base: Training and Quality Assurance Model for Low-Volume Centers

Bostjan Lanisnik 1, Janez Ravnik 2, Carl Snyderman 3, Paul Gardner 3
  • 1Department of ENT-Head and Neck Surgery, University of Maribor, Maribor, Slovenia
  • 2Department of Neurosurgery, University of Maribor, Maribor, Slovenia
  • 3Center for Cranial Base Surgery, University of Pittsburgh, Pittsburgh, United States

Objective: Proficiency in endoscopic endonasal surgery (EES) of the skull base is difficult to achieve without a mentoring relationship. We describe results of EES in a low volume center using a novel training and quality assurance model in collaboration with a high volume skull base center.

Methods: After proficiency was achieved by the skull base team in Slovenia for extradural pathology, EES for intradural pathology was performed with a direct collaboration between the team in Slovenia and a much more experienced team in Pittsburgh, facilitated by telemedicine technology. Features of the collaboration included: (1) Observation fellowship at the Center for Cranial Base Surgery in Pittsburgh, (2) On-site instruction in Slovenia, (3) Remote telementoring of complicated cases, and (4) Assistance with decision-making process before and after surgery.

Results: From July 2010 to Sept. 2015, the team in Maribor performed 129 skull base procedures for benign and malignant pathology. The rate of major complications (visual loss, CSF leak, major hemorrhage) was 8%. Telementoring was used in 10 advanced skull base cases; adequate audio and video communication was achieved in 9 cases. Multiple benefits of telementoring were noted in surveys at both sites.

Conclusion: With proper training, surgical telementoring by a major comprehensive skull base center facilitates safe EES even in a low volume environment.