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  Report of the International Symposium in Endoscopic Skull Base Surgery, Malaysia. 22-25th July 2009

Introduction


The International Symposium in Endoscopic Skull Base Surgery 2008 was successfully co-organized by the Department of Neurosurgery, Hospital Kuala Lumpur , Neurosurgical Association of Malaysia, Universiti Putra Malaysia (UPM) with the support of Malaysia Ministry of Health, Neuroscience Foundation of Malaysia, Karl Storz Endoscopy and United Malaysian Medical Industries (UMMI). It was held at the Medical Faculty and Allied Health Sciences, Universiti Putra Malaysia, Serdang- Selangor and Hospital Putrajaya from 22nd to 25th July 2008.

This course was designed to update the delegates on recent development of endoscopic treatment of midline intracranial skull base lesions through a series of lectures, practical demonstrations on endoscopic instruments, hands-on cadaveric Workshop and live demonstration surgery involving various procedures with special highlights on endoscopic endonasal and endoscopic assisted transcranial (supraorbital) minimal invasive approaches to the skull base. A full day session, specially dedicated to nurses and paramedics was also included to ensure parallel development among the support staff.

In addition to the local faculties, we were very fortunate to receive assistance and participation of international experts from different institutions to share their valuable knowledge and experience during this course especially our guest speakers, Dr. Cleopatra Charalampaki from University of Graz, Austria who has been helping us since our first course in 2007, Prof. J Andre’ Grotenhuis from University Medical Center St. Radboud-Nijmegen, The Netherlands, Assoc. Prof. E Deopujari from Bombay Hospital Institute of Medical Sciences, Mumbai, India and Dr. Daniel Prevedello from University of Pittsburgh, United States of America. The combination of local – international speakers and senior – young Neurosurgeons has made this course more stimulating and rewarding.

Attendances

Overall, we received a total of 66 participants mainly from Malaysia (59) and also from other neighboring countries including Indonesia (2), Bangladesh (2), India (1), Singapore (1) and Brunei (1).

Final Programme

The 4-days course generally followed the agenda as shown in Appendix. A. and divided into 3 parts:

  • Course for Nurses (Lectures & Practical Training 1 & 2) on 22nd July 2008 
     
  • Course for Doctors (Lectures & Practical Training 1-4) on 23-24th July 2008
    - At lecture Hall 2 and Anatomy Dissection Hall (UPM) 
     
  • Live demonstration surgery on 25th July 2008 (Hospital Putrajaya)


A total of 19 lectures were delivered by eleven speakers from various institutions throughout the course. The lists of speakers as follows;

  1. Professor Dr. Joachim Andre’ Grotenhuis
    Professor and Chairman, Department of Neurosurgery,
    University Medical Center St. Radboud-Nijmegen, the Netherlands.
  2. Associate Professor Dr. Chandrasekhar E. Deopujari
    Consultant Neurosurgeon, Bombay Hospital Institute of Medical Sciences,
    Mumbai, India. 
     
  3. Professor Nasaruddin Abdul Aziz
    Professor of Anatomy, Cyberjaya Medical University, Cyberjaya, Malaysia.
  4. Dr. Cleopatra Charalampaki
    Consultant Neurosurgeon, University of Graz, Austria.
  5. Dr. Daniel Monte-Serrat Prevedello
    Clinical Instructor, Director of Anatomy Laboratory,
    Department of Neurosurgery University of Pittsburgh,
    United States of America 
     
  6. Dr. Azmi Alias
    Consultant Neurosurgeon,
    Department of Neurosurgery, Hospital Kuala Lumpur, Malaysia.
  7. Dr. Khairul Muhsein Abdullah
    University Putra Malaysia. 
     
  8. Roman Krohn
    OR Nurses, Johannes- Gutenberg University of Mainz, Germany
  9. Saw Hui Min
    Karl Storz-UMMI Malaysia
    Humedical, Asia 
     
  10. S. Jayaveeran
    BrainLab, South East Asia.
  11. Dr. Gerwin Gerke
    Humedical, Asia.

Course for Nurses / Paramedics

The event began on 22nd July 2008 with the course for nurses and paramedics. A total of 30 participants from Neurosurgical and ENT fraternity, mainly from local institutions including public, universities and private hospitals attended the course. Six lectures were delivered covering various topics ranging from historical aspects of neuroendoscopy, basic handlings and maintenance of endoscopic equipments, intraoperative navigation, hemostasis and CSF sealing. This was followed by hands-on practical training session 1 & 2, where the participants had the opportunity to practice the theoretical knowledge obtained earlier in the morning session. They were guided by facilitators dedicated to each workstations in the laboratory ( Anatomy Dissection Hall). Participants were further divided into 5 different groups and rotated within these workstations.

5 workstations were prepared for different activities including;

  1. Neuroendoscopic equipments: Handlings and set up ( Roman Krohn) 
     
  2. Maintenance and sterilization of neuroendoscope (Storz-UMMI) 
     
  3. Video, Camera & documentation devices (Storz-UMMI) 
     
  4. Hemostasis and CSFsealing : Preparation and techniques (Baxter-Humedical) 
     
  5. Intraoperative neuronavigation equipments and set-up (BrainLab)

Course for Surgeons

The 3-days course for surgeons consists of two parts :

  1. Lectures & Practical Training at University Putra Malaysia (23-24, July 2008)
    Day 1 - Endoscopic Endonasal Approach for Midline Anterior Skull Base
    Day 2 - Endoscopic Endonasal Approach for Midline Posterior Skull Base &
    Craniocervical junction. 
     
  2. Live Surgery at Hospital Putrajaya (25, July 2008)

Dr. Azmi Alias, as a course director facilitated the course which began on 23rd July 2008. It started with welcome speeches by Prof. Liew representing Prof. Dr. Azhar Mohd Zain, Dean of the Medical Faculty, Universiti Putra Malaysia, followed by Dr. Chee Chee Pin as a President of the Neurosurgical Association of Malaysia and finally Dr. Mohammed Saffari Mohammed Haspani from Department of Neurosurgery, Hospital Kuala Lumpur as the Organizing Chairman. It was attended by 36 participants, consists of 26 Neurosurgeons and trainees, and 10 ENT Surgeons.

Symposium for Surgeons. In brief, the first day was focusing on the endoscopic endonasal approaches for sellar, suprasellar and anterior cranial fossa while the second day on the posterior fossa and craniocervical junction. Various topics were discussed during the theoretical session in the morning followed by hands-on practical session in the afternoon. The key hole approach and minimally access surgery using the endoscopic equipments was the main concepts of this course. The participants were exposed to the fundamental knowledge of endoscopic approaches including practical endoscopic anatomy of nasal cavities, endonasal and intracranial areas of entire midline skull base, indications and various endonasal techniques with special highlights on the recent development in expanded endonasal approach to the entire midline intracranial skull base lesions and endoscopic assisted key hole supraorbital craniotomy.

Hands-on practical training for Surgeons. Total 10 cadaveric (fixed, formalin) workstations were prepared. Each workstation was equipped with high speed drills, TV monitor and the latest endoscopic equipments for cranial and endonasal skull base, specially shipped from Tuttlingen, Germany by Karl Storz Endoscopy-UMMI. The endoscopic sets included Martin-Bertagg, Thumfarts for endonasal skull base and Decq for ventricular endoscopy.

Three additional workstations were also prepared for anatomical specimens, navigation systems (BrainLab) and books for references. A live transmission of the hands- on practical training activities to the lecture hall was organized and viewed by the undergraduate medical students and other observers.

Participants were divided into 10 groups, each group consists of Neurosurgeons, ENT surgeons, assisting operating nurse and support engineer. Participants were preliminarily exposed to live demonstration on various endoscopic endonasal techniques by Dr. Cleopatra Charalampaki, Prof. J Andre’s Grotenhuis, Dr. Daniel Prevedello and Dr. C.E.Deopujari prior to their hands-on practical training sessions. They also had the great opportunity to discuss with the international experts on the challenges, pitfalls, various “tips and tricks” on the endoscopic techniques.

Social Events

Social programmes were included Putrajaya’s Lake Cruise Dinner on 23rd July 2008 and visit to Kuala Lumpur City Centre Sky’s bridge on 24th July 2008.

It was a memorable evening for 60 participants including the spouses from our international faculties to have the unique dining experience on board of a luxury boat (Kelah), cruising pass the scenic sights of Malaysia’s futuristic city in Putrajaya. The highlights of the dinner was speeches delivered by Dr. Mohammed Saffari and all of the international guest speakers.

A special arrangement was also made to allow the participants to visit the exclusive second floor of KLCC skybridge at Level 42 on 24th July 2008, around 8:00pm, which also the highest 2-storey skybridge in the world. This visit remarked the unforgettable view of Kuala Lumpur at night and the “endoscopic view” of KLCC twin tower which can only be seen from the second level of the bridge.

Live Surgery at Hospital Putrajaya

Preparation for the live surgery began very much earlier with communication and establishment of combined team consists of multiple disciplines lead by Neurosurgical team from Department of Neurosurgery, Hospital Kuala Lumpur, Medical Endocrine and Anaesthesiology team from Hospital Putrajaya and two invited Neurosurgeons, Dr. Cleopatra Charalampaki from Austria and Prof. J Andre’ Grotenhuis from Nijmegen, the Netherlands.

Several problems such as logistics, equipments and case selections were sorted out prior to the course. A Temporary Practising Certifcate was obtained from Malaysian Medical Council to allow the invited Neurosurgeons ie. Dr. Cleopatra Charalampaki and Prof. J Andre’ Grotenhuis to take part in the surgery. Three cases of craniopharyngioma, pituitary macroadenoma and sellar meningioma were selected and consented for surgery. They were reviewed and optimized in the combined Neuroendocrine clinic at Hospital Kuala Lumpur. The team decided to perform an endoscopic endonasal resection on the case of Craniopharyngioma first at Neurosurgical Operation Theatre, Hospital Kuala Lumpur on 21st July 2008, while surgery for the other two patients were scheduled at Hospital Putrajaya.

The half-day live demonstration surgery was finally performed at Hospital Putrajaya on 25th July 2008 involving the case of Pituitary Macroadenoma, who presented with visual impairment. The surgical team consists of Dr. Cleopatra Charalampaki, Prof. Dr. J.Andre’ Grotenhuis and Dr. Azmi Alias, assisting nurses from Department of Neurosurgery and Hospital Putrajaya, the anaesthesiology team was lead by Dr. Fauziah Mohd Yusof and Dr. Lim Wee Leong while medical endocrine team by Dr. Zanariah Hussein.

The participants had the opportunity to observe the surgery in the auditorium through live transmission with interactive discussion, facilitated by Dr. Daniel Prevedello and Prof. J Andre’ Grotenhuis. Participants were exposed to the operative steps starting from positioning, preparation of the nasal cavities, handlings of the endoscopic equipments, utilization of intraoperative neuronavigation, endoscopic endonasal transphenoidal approach of tumour removal and completion of the surgery. Due to time constraints, surgery for the case of sella meningioma was rescheduled to later date. The course finally concluded by Dr. Mohammed Saffari with closing speech and delivery of certificates of attendance to the delegates and the invited speakers.

Closing

The successful collaboration between public, universities, medical industries and international experts in organizing this event was considered to be worthwhile and has created a pathway in promoting academic activities and training to the higher level. It was concluded that the course was successful and has achieved it’s objectives.

Prepared by

Dr. Azmi Alias,
Course Director, International Symposium in Endoscopic Skull Base Surgery,
Malaysia 2008
01 January 2009

ACKNOWLEDGEMENT
The organizing Committee wishes to express its sincere appreciation to the following individual and establishments for their invaluable support:

  • Tan Sri Datuk’ Dr. Hj Mohd Ismail Merican
    ( Director General of Health, Malaysia) 
     
  • Gen. (Rtd) Tan Sri Dato’ Mohd Ghazali bin Dato’ Mohd. Seth
    (Neuroscience Foundation of Malaysia) 
     
  • Prof. Azhar Mohd Zain ( Dean. Medical Faculty, UPM) 
     
  • Datuk Dr. Noor Hisham Abdullah
    ( Deputy, Director General of Health (Medical), Malaysia) 
     
  • Dato’ Dr. Azmi Shapie
    ( Director of Medical Development, Malaysia Ministry of Health) 
     
  • Dato’ Dr. Zaininah Bte. Mohd Zain (Director, Hospital Kuala Lumpur) 
     
  • Dr. Johari Adnan ( Head Coordinator of Neurosurgical Services Malaysia) 
     
  • Dr. Mohd Norzi bin Ghazali ( Director, Hospital Putrajaya)
     
  • Dr. h.c .mult. Sybill Storz ( Karl Storz Endoscopy, Tuttlingen,Germany) 
     
  • Dr. Mohd Aris Mohd Moklas (Department of Anatomy, UPM) 
     
  • Dr. Mohd Bakri Ishak ( Principle, Kolej-17 UPM) 
     
  • Pn. Nor Azlina Zainal Abidin ( Head, Information and Technology Unit, FMHS, UPM) 
     
  • Saw Teck Hui & Cindy Teh ( United Malaysian Medical Industries ) 
     
  • Jayaveraan Shunmuganathan ( BrainLab, South-East Asia) 
     
  • United Malaysian Medical Industries (UMMI) Brain Lab, South-East Asia 
     
  • Humedical ( Baxter) Johnson & Johnson 
     
  • Pfizer CommerMega Marketing Sdn. Bhd. 
     
  • Fresenius Kabi Tourism Malaysia.

Co-organised by :

 



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