NASBS 2022 Annual Meeting Program

Session concentrates on the nuances of the clivus and its most common pathology: chordoma. At the conclusion of this session, attendees will be able to:

• Be able to recognize the diverse pathology of the clivus.
• Understand that the pathology of the clivus may depend on imaging.
• Gain appreciation for upcoming molecular impact in diagnosis and treatment of clival pathologies.

This session concentrates on Sinonasal malignancies such as squamous cell carcinoma, neuroendocrine tumors, and melanoma with skull base involvement. At the conclusion of this session, attendees will be able to:

• Understand Imaging Modalities useful in prognostication and surgical planning for Sinonasal malignancies.
• Understand the impact of quality of life with treatment of sinonasal malignancies.
• Gain appreciation for cutting edge knowledge relative to sinonasal malignancies.

The session is designed to place a spotlight on the effective researchers in our NASBS cohort, as well as motivate us all to get more involved in funded research. At the conclusion of this session, attendees will be able to:

• Gain an appreciation for research beyond case series performed relative to skull base in our membership.
• Gain a basic understanding of lab mechanics and establishment.
• Motivate NASBS membership to work toward more basic research in Skull base relevant basic and translational science.

Peri-neural Spread in head and neck malignancies represents a challenging clinical and surgical problem, here from experts regarding the nuances of the impact in treatment of peri-neural spread.

At the conclusion of this session, attendees will be able to:

• Describe peri-neural spread and its impact on treatment.
• Gain understanding for imaging that may help in identifying peri-neural spread in head and neck malignancies.
• Understand treatment options available in cases of peri-neural spread in head and neck malignancies.

This session concentrates avoidance and management of skull base complications.

At the conclusion of this session, attendees will be able to:

• Understand how preoperative study/planning may help in avoiding complications.
• Gain tips and tricks to avoid unintentional nerve injury during surgery.
• Gain appreciation for management of complications.

This expert debate session will focus on concurrent and overlapping skull base surgeries in the operating room setting. Legal and ethical implications for running multiple rooms will be discussed.

At the conclusion of this session, attendees will be able to:

• Identify legal implications of running multiple rooms.
• Identify ethical implications of running multiple rooms.
• Develop a strategy for running multiple rooms that optimizes patient care.

This expert debate session will feature case discussions of patients with small acoustic neuromas. Controversies surrounding management options—observation, radiation, surgery—will be highlighted.

At the conclusion of this session, attendees will be able to:

• Identify treatment modalities for small acoustic neuromas.
• Discuss benefits and pitfalls of each treatment modality.
• Formulate a treatment algorithm that can be applied in a clinical setting.

At the conclusion of this session, attendees will be able to:

• Develop a differential diagnosis for patients with small round blue cell tumors.
• Identify treatment options for patients with small round blue cell tumors.
• Formulate a treatment algorithm that can be applied in a clinical setting.

This expert debate session will feature case presentations of skull base malignancies with perineural invasion involving Zone 2, particularly the cavernous sinus. Management strategies will be discussed, with an emphasis on the controversies surrounding surgery versus radiation.

At the conclusion of this session, attendees will be able to:

• Describe clinical presentation of patients with malignant tumors with perineural invasion into Zone 2.
• Identify treatment options for these patients.
• Discuss the risks and benefits of surgery versus radiation.

This expert debate session will feature case presentations of recurrent nasopharyngeal carcinoma. Management strategies will be discussed, with an emphasis on the controversies surrounding salvage surgery versus re-irradiation.

At the conclusion of this session, attendees will be able to:

• Identify treatment options for patients with recurrent nasopharyngeal carcinoma.
• Discuss the pros and cons of salvage surgery vs re-irradiation.
• Develop a framework for assisting patients to make an informed treatment decision.

Review the ability to preserve hearing with surgical or radiosurgery treatment of vestibular schwannomas. In addition, we will review hearing augmentation options to assist in hearing preservation. This session should be attended by neurosurgeons, otologists and radiation oncologists.

At the conclusion of this session, attendees will be able to:

• Compare hearing outcomes for surgery and radiosurgery in the treatment of vestibular schwannomas.
• Evaluate the most appropriate treatment option given the characteristics of the vestibular schwannoma.
• Integrate hearing augmentation devices into treatment algorithms for hearing preservation.

Review the treatment options for craniopharyngioma which may be utilized to preserve endocrine and neurologic function. This session should be attended by neurosurgeons, ophthalmologists, radiation oncologists, and endocrinologists.

At the conclusion of this session, attendees will be able to:

• Evaluate which surgical approach results in the highest rate of preservation of function.
• Compare the functional preservation associated with radiation versus surgical resection of craniopharyngioma.
• Predict functional outcome associated with the treatment of craniopharyngioma.

A review of the surgical approaches as well as non-surgical treatment of trigeminal schwannoma. This session should be attended by neurosurgeons, ENT surgeons, and radiation oncologists.

At the conclusion of this session, attendees will be able to:

• Compare surgical approaches for the treatment of trigeminal schwannoma.
• Evaluate the outcome of radiation treatment for trigeminal schwannoma.
• Develop the most appropriate treatment option for trigeminal schwannoma.

Review the different surgical approaches to cavernous sinus pathologies with an emphasis on neurologic outcome. This session should be attending by Neurosurgeons, Otolaryngologists, Ophthalmologists, and Radiation Oncologists

At the conclusion of this session, attendees will be able to:

• Evaluate the advantages and disadvantages of open versus endoscopic approaches to cavernous sinus pathology with an emphasis on neurologic outcome.
• Evaluate the functional outcomes associated with radiation and radiosurgery for treatment of cavernous sinus lesions.
• Review the natural history of common cavernous sinus pathologies in regards to the risk of treatment.

Video session demonstrating complex cases utilizing novel approaches to the posterior fossa. Neurosurgery, Neuro-otology, Neuroradiology providers/fellows/residents and associated care providers will benefit from the unique video presentations.

At the conclusion of this session, attendees will be able to:

• Recognize optimal approaches for complex posterior fossa pathologies.
• Develop/Evolve a complex posterior fossa reconstruction ladder based on video presentations presented.
• Recognize limitations and inclusion/exclusion criteria based on video and oral presentations.

This session will explore orbital pathologies and surgical approaches from a multidisciplinary perspective. Skull Base Surgeons with backgrounds in Neurosurgery, Otolaryngology, Ophthalmology, Neuroradiology and fellows/residents/advanced care team providers will benefit from this session.

At the conclusion of this session, attendees will be able to:

• Identify novel/nuanced multi-disciplinary techniques for advanced orbital pathology.
• Implement novel approaches and repair techniques into practice for orbital pathologies.
• Develop multidisciplinary consideration of approach for complex skull base and orbital pathologies.

This session highlights complex suprasellar and anterior fossa approaches in a clinically relevant, video-based format. Multidisciplinary Skull Base Teams with backgrounds in Neurosurgery, Otolaryngology, Ophtahlamology, Neuroradiology and fellows/residents/advanced care team providers will benefit from this session.

At the conclusion of this session, attendees will be able to:

• Assess utility of video-demonstrated approaches to complex Anterior Fossa and Suprasellar pathologies.
• Compare risks and benefits of open vs endoscopic approaches to Anterior Fossa and Suprasellar pathologies.
• Recognize multiple extirpative and reconstructive techniques that may be implemented for Anterior Fossa and Suprasellar pathologies.

This session will provide video-based presentations of expert-level petrous apex and petroclival pathologies and related approaches. Pros and cons of surgical, pathology-specific and reconstructive considerations relative to the practices of neurosurgeryneurosurgy, otolaryngology (head and neck, neuro-otology and rhinology), neuroradiology, and fellows/residents/advanced care team providers will be examined.

At the conclusion of this session, attendees will be able to:

• Determine appropriate open anterior, endoscopic and lateral approaches for pathologies of the petrous apex and petroclival regions.
• Recognize disease and anatomic considerations of lesions in these areas that may portend post treatment aspects.
• Distinguish limitations of current treatment options as well as optimal cases for combined approaches.

The NASBS Research Committee is pleased to update the membership on the work being done on behalf of the NASBS membership for the past year.  In addition, we will be announcing the winners of the latest NASBS research grant cycle.  We will be showcasing research supported by NASBS research grants to update the membership on the work being done to move our field further forward. 

At the conclusion of this session, attendees will be able to:

• Discuss the work being done by the NASBS under the purview of the Research Committee and how it relates to the practice of skull base surgery
• Summarize the relevance of research and scholarly activity supported by the NASBS through the Research Committee
• Synthesize ways that the research and scholarly activities of NASBS under the auspice of the Research Committee can apply to one’s own body of work and knowledge.

After common maximal treatment of skull base meningiomas with cranial nerve involvement, some treatments fail.  This session concentrates on practice management of meningiomas resistant to standard therapy.

At the conclusion of this session, attendees will be able to:

• Understand standard therapy for common skull base meningiomas.
• Gain appreciation for management strategies of skull base meningiomas resistant to standard therapy.
• Understand the impact of WHO grade on management strategy for meningiomas.

Orbital and Transorbital surgery is becoming more reliant on skull base teams often with ophthalmology, ENT, and Neurosurgery involved. This session highlights state of the art orbital surgery.

At the conclusion of this session, attendees will be able to:

• Gain appreciation of the anatomy pertinent to endoscopic orbital surgery.
• Understand modern management of graves ophthalmopathy.
• Gain practical knowledge of orbital and transorbital surgery useful to your practice.

Endovascular surgery plays a critical role in assisting quality skull base surgery, this session aims to provide a global overview of endovascular surgery`s importance in the comprehensive skull base team.

At the conclusion of this session, attendees will be able to:

• Understand the spectrum of embolization techniques and how they can help you. 
• Understand how carotid occlusion studies help predict surgical need for bypass and risk of ischemic complications.
• Gain appreciation of carotid artery injury management and the role of endovascular surgery.

Glomus tumors represent an uncommon yet critical tumor to understand for skull surgery teams, this session aims to further education and provide state of the art treatment for these complex tumors.

At the conclusion of this session, attendees will be able to:

• Understand the Genetics of Glomus tumors.
• Gain an appreciation of the complexity of Glomus tumors.
• Continue to develop practice management parameters for Glomus tumors.

Endonasal and transcranial routes are competing but also complementary approaches to the skull base. In this session we will review the surgical anatomy of the paraclinoidal and suprasellar space, and we will discuss the pros and cons of endonasal and transcranial approaches to these regions. Attendance is recommended for all trainees and skull base specialties with an interest in treating pathology located in the suprasellar and paraclinoidal regions.

At the conclusion of this session, attendees will be able to:

• Develop a better understanding of the surgical anatomy of the paraclinoidal and suprasellar regions.
• Recognize key surgical landmarks and technical nuances for the endonasal and transcranial approaches to the paraclinoidal and suprasellar regions.
• Compare the benefits and disadvantages of endonasal and transcranial approaches to the paraclinoidal and suprasellar regions.

This expert debate session will feature discussions surrounding the benefits and pitfalls of proton versus photon-based radiotherapy. Moderators will present cases to expert panelists, who will offer insights on the indications for each treatment modality.

At the conclusion of this session, attendees will be able to:

• Recognize the key differences between proton and photon-based radiotherapy.
• Discuss evidence-based outcomes for proton therapy.
• Develop a treatment algorithm that includes both types of radiotherapy.

This expert debate session will feature case presentations and discussions surrounding the optimal treatment strategy for jugular foramen paragangliomas.

At the conclusion of this session, attendees will be able to:

• Recognize the benefits and pitfalls of surgery vs radiation in the management of jugular foramen paragangliomas.
• Develop a treatment algorithm that can be applied in the clinical setting.
• Develop a framework for assisting patients to make an informed treatment decision.

This expert debate session will feature challenging cases of skull base meningiomas. Management strategies will be discussed, with an emphasis on surgical approaches.

At the conclusion of this session, attendees will be able to:

• Identify the various surgical approaches for skull base meningiomas.
• Recognize the pros and cons of each surgical approach.
• Discuss the role of nonsurgical therapy for meningiomas.

This expert debate session will feature case presentations of T4b sinonasal malignancies involving the skull base and infratemporal fossa. Management strategies will be discussed, with an emphasis on the controversies surrounding surgery versus neoadjuvant chemoradiation.

At the conclusion of this session, attendees will be able to:

• Identify and evaluate treatment options for patients with sinonasal malignancies involving the skull base and infratemporal fossa.
• Discuss evidence-based outcomes and controversies for each treatment modality.
• Develop a framework for assisting patients to make an informed treatment decision.

This expert debate session will feature discussions surrounding coding and reimbursement strategies for skull base surgical procedures. Listed vs. unlisted coding will also be discussed.

At the conclusion of this session, attendees will be able to:

• Discuss best practices pertaining to coding and reimbursement in skull base surgery.
• Recognize pitfalls in compliance.
• Identify opportunities for updating procedure terminology and coding.

Review the different treatment options and approaches for tumors involving the jugular foramen.  This should be attended by neurosurgeons, head and neck surgeons, otolaryngologists, and radiation oncologists.

At the conclusion of this session, attendees will be able to:

• Evaluate the different surgical approaches to the jugular foramen.
• Evaluate the radiotherapy options for the treatment of jugular foramen tumors.
• Develop a multimodality algorithm for management of jugular foramen tumors.

Review the multimodal treatment options necessary for treatment of chordomas and chondrosarcomas. This should be attended by neurosurgeons, otolaryngologists, radiation oncologist, and medical oncologists.

At the conclusion of this session, attendees will be able to:

• Recognize the appropriate surgical approach or combination of approaches necessary to achieve maximum resection.
• Implement an appropriate radiation therapy strategy.
• Understand the utility of tumor biology for the management of these tumors.

Disease control strategies for benign and malignant skull base tumors have primarily focused on surgery and radiation options, however, medical options are emerging in the management of these tumors as well. This sessions will focus on providing an update on contemporary and emerging medical treatments for selected benign and malignant skull base tumors. Any provider who cares for these tumors is encouraged to attend to learn about these options.

At the conclusion of this session, attendees will be able to:

• Identify skull base tumors which have targetable mutations for systemic therapy.
• Distinguish which patients are appropriate for systemic therapy options.
• Identify where to find active clinical trials that are appropriate for skull base tumor patients.

This session is dedicated to using other’s “biggest challenges” as a way to identify the barriers to the recruitment of women to skull base in order to be able to develop realistic solutions to create change. Participants should include both men and women dedicated to this effort.

At the conclusion of this session, attendees will be able to:

• Identify the barriers to recruitment of women in skull base at large (and at their respective institutions).
• Use the experience of others to predict future challenges.
• Develop realistic strategies of how to react to and solve these challenges.
• Recognize national mentors.

Endoscopic endonasal and transcranial approaches are competing but also complementary approaches to the skull base. In this session we will review the 3D surgical anatomy of the cavernous sinus, Meckle’s cave, middle fossa and petrous apex, and we will discuss the pros and cons of endonasal and transcranial approaches to these areas. Attendance is recommended for all trainees and faculty with an interest in managing pathology in these locations.

At the conclusion of this session, attendees will be able to:

• Develop a better understanding of the surgical anatomy of the cavernous sinus, Meckle’s cave, middle fossa and petrous apex regions.
• Recognize key surgical landmarks and technical nuances for the endonasal and transcranial approach to the cavernous sinus, Meckle’s cave, middle fossa and petrous apex regions.
• Compare the benefits and disadvantages of endonasal and transcranial approaches to the cavernous sinus, Meckle’s cave, middle fossa and petrous apex regions.

Vascular injuries in skull base surgery, although rare, may lead to catastrophic consequences. Neurosurgery, Otolaryngology and skull base surgeons and fellows/residents/advanced care providers from all subspecialties should attend.

At the conclusion of this session, attendees will be able to:

• Diagnose areas of high risk for vascular injury.
• Recognize landmarks that may assist with injury prevention.
• Identify immediately and long-term treatment considerations when vascular injuries occur in skull base surgery.

This video session focuses on approaches and techniques to optimize surgical treatment of disease in the pituitary and sellar region. Neurosurgery, Otolaryngology and anterior skull base teams/providers/fellows/residents and advanced care providers should attend.

At the conclusion of this session, attendees will be able to:

• Recognize anatomic landmarks that assist with expert level pituitary pathologies.
• Discriminate between advanced, resectable disease processes and plan for potential extended/alternative approaches.
• Employ extirpative and reconstructive approaches for consideration in appropriate candidates.

This session will focus on how imaging advances are helping better understand the relationship of various skull base pathologies with normal anatomy as well as more precisely predict behavior of these pathologies and their subsequent outcome after treatment. All providers who diagnose and follow a variety of skull base pathologies are encouraged to attend.

At the conclusion of this session, attendees will be able to:

• Recognize the ability and limitations of imaging to predict invasiveness of benign and malignant skull base tumors.
• Distinguish how imaging can help identify the location of cranial nerves and how that knowledge translates into the clinical setting.
• Articulate how machine learning can help predict behavior of cerebral aneurysms as well as classify and predict outcomes after surgery for tumors.

This session will focus on the `how to` aspects of building a practice. Within skull base surgery, specific focus will be placed on partnership building and balance high quality outcome expectations with gaining experience. Residents, fellows, and skull base surgeons early in practice will most benefit from this session.

At the conclusion of this session, attendees will be able to:

• Identify factors that set up successful skull base partnerships.
• Balance priorities between gaining experience, educating trainees, and optimizing patient outcomes.
• Employ strategies that will lead to successful professional development during the early phase of surgical career.

Endoscopic endonasal and transcranial approaches are competing but also complementary approaches to the skull base. In this session we will review the 3D surgical anatomy of the petroclival region, and we will discuss the pros and cons of endonasal and transcranial approaches to this complex area. Attendance is recommended for all trainees and faculty with an interest in managing pathology in this location.

At the conclusion of this session, attendees will be able to:

• Develop a better understanding of the surgical anatomy of the petroclival region.
• Recognize key surgical landmarks and technical nuances for the endonasal and transcranial approach to the petroclival region.
• Compare the benefits and disadvantages of endonasal and transcranial approaches to the petroclival region.

This session will focus on technological advances that help in the presurgical planning process and technology/techniques used intraoperatively that help result in both more extensive yet safe surgery. This session is primarily focused for skull base surgeons.

At the conclusion of this session, attendees will be able to:

• Understand how 3-D printing is implemented into the preoperative planning process in skull base surgery.
• Appreciate how intraoperative visualization and histopathological techniques are used in skull base surgery and how to implement them.
• Assess the role of robotics in skull base surgery.
• Identify how to minimize exposure to surgical team during skull base surgeries during the COVID-19 pandemic.

This session will focus on diagnostic challenges prior to surgery, intraoperative surgical strategies for MRI-negative Cushing`s Disease, and treatment strategies for patients who fail to achieve remission. It is mainly focused for neurosurgeons, endocrinologists, and radiologists who care for patients with Cushing`s disease.

At the conclusion of this session, attendees will be able to:

• Distinguish the appropriate diagnostic thought process both prior and after a negative MRI scan of the pituitary gland.
• Recognize high-yield imaging strategies to identify pituitary tumors when ACTH-dependent hypercortisolism is diagnosed.
• Identify the different surgical strategies employed for MRI-negative Cushing`s disease and understand their respective advantages/disadvantages.
• Recognize the role of radiosurgery and systemic medical options for patients that fail to achieve remission or have recurrence of Cushing`s disease.

Neuromonitoring is essential to optimize outcomes in vestibular schwannoma surgery. In this session, standard techniques will be reviewed as well as cutting-edge advances that are focused on facial nerve and hearing preservation and how to implement them into practice. This session is primarily for neurosurgeons and neuro-otologists, but the perspective can also be helpful for reconstructive surgeons and audiologists.

At the conclusion of this session, attendees will be able to:

• Recognize the different neurophysiological monitoring techniques and the role they play in vestibular schwannoma surgery.
• Strategize how to optimize neurophysiological monitoring strategies so they translate into better patient outcomes.
• Discriminate the differences that exist in operative goals in NF-2 related vestibular schwannomas and how to adjust neurophysiological monitoring techniques.

This session is intended to help with skills and important resources needed to establish a  skull base lab and build a skull base practice.

At the conclusion of this session, attendees will be able to:

• Gain an appreciation on how to establish resources needed to set up and run a skull base lab.
• Gain an understanding of the elements that are necessary for building a focused skull base practice.
• Open forum discussion on areas of need for the Early Career Skull Base Surgeon.

Endoscopic endonasal and transcranial approaches are competing but also complementary approaches to the skull base. In this session we will review the 3D surgical anatomy of the Lower Clivus and Foramen Magnum regions, and we will discuss the pros and cons of endonasal and transcranial approaches to these regions. Attendance is recommended for all trainees and faculty with an interest in managing pathology in these locations.

At the conclusion of this session, attendees will be able to:

• Develop a better understanding of the surgical anatomy of the Lower Clivus and Foramen Magnum.
• Recognize key surgical landmarks and technical nuances for the endonasal and transcranial approach to the Lower Clivus and Foramen Magnum.
• Compare the benefits and disadvantages of endonasal and transcranial approaches to the Lower Clivus and Foramen Magnum.

This expert debate session will focus on concurrent and overlapping skull base surgeries in the operating room setting. Legal and ethical implications for running multiple rooms will be discussed.

At the conclusion of this session, attendees will be able to:

• Identify legal implications of running multiple rooms.
• Identify ethical implications of running multiple rooms.
• Develop a strategy for running multiple rooms that optimizes patient care.