John G. Strugar, M.D.
Mission
The Skull Base Program at Yale is dedicated to treating tumors and lesions located at the base of the brain and basicranium, in a collaborative effort between Neurosurgery, Otolaryngology and Plastic Surgery, with the goal of eradicating the disease process while optimizing, maintaining and when necessary reconstructing neurological function.
Clinical Care
Tumors and other lesions of the skull base are by virtue of their location surgically challenging and require a collaborative and highly comprehensive approach. The Skull Base Program at Yale functions as s part of Neuro-Oncology, with equal input from Otolaryngology and in close association with Plastic Surgery. As patients present, or are referred to either specialty, it is imperative that these services collaborate closely when appropriate. The aim of therapy is to cure the disease process, maintain neurologic function, and preserve cosmesis. Various surgical and non-surgical approaches are weighed, with patients being given realistic expectations of long-term outlook and surgical results. To achieve the absolute best results, an extensive array of state-of-the-art diagnostic tools is initially used to assess the extent of the disease process. This includes helical CT scans with CT angiographic ability, MRI, MR Angiography, MR Venography, PET Scan, Cerebral Angiography with super-selective catheterization capacity, full battery of cranial nerve electrophysiologic evaluation as well as functional swallowing and vocal cord assessment. Furthermore, when indicated, test balloon occlusion of carotid of vertebral arteries and when safe, endovascular occlusion as well as tumor embolization, both increase the safety and chance of total resection of tumors. Intra-operatively, a full battery of electrophysiological cranial nerve monitoring, as well as somatosensory and brainstem evoked potential monitoring allow for functional physiologic feedback for safer tumor removal. State-of-the-art equipment, including frameless stereotaxy facilitate navigation in complex anatomical planes. A dedicated neuro-anesthesia team complements the surgical team in providing brain protection while allowing unimpeded electrophysiological monitoring. Post-operatively, the patients are cared for in a dedicated ten bed Neurosurgical Intensive Care Unit with extensive experience in treating neurologically challenged, critical ill patients. Should the patient need rehabilitation, a full array of neurological therapy is readily available to patients. For a subset of patients, radiosurgery, which at present is offered with the LINAC system and in the fall of '97, with the Gamma Knife, it will complement the therapeutic course. The goal will be to allow the eradication and control of a difficult disease process, while maintaining neurological function.
Research
The Skull Base Program focus will be on techniques to maximize neurological function while facilitating total tumor resection. Currently laboratory investigation of minimally invasive procedures to achieve tumor resection is being supplemented by enhancement of computer aided three dimensional mapping of tumor and cranial nerves.
Education
The very complex nature of skull base anatomy, pathophysiology and management demands a concerted and varied approach to the education of medical students, residents and physicians. To that end, a novel multi-media approach, with computer-enhanced images, supplementing cadaveric anatomical dissection is to be used in the education of students and residents in skull base pathology. As the only Skull Base Program in Connecticut ( and the only Program between NYC and Boston), it is incumbent upon the Yale Program to provide the continuing medical education of interested physicians in our area.
The Yale Skull Base Surgery Program can be reached at 203-735-2791
or email to: joseph.piepmeier@yale.edu
Neurosurgery Faculty/Program Menu
Department of Neurosurgery address and phone number
http://info.yale.med.edu/surgery/neurosur/neuroonco.html
credits
