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Skull Base Surgery Trends and New Developments Revisited: An update from Bruce J. Gantz, MD: Ten Years Later.

The University of Iowa is among the most comprehensive Otolaryngology--Head and Neck Surgery Departments in the world. In 2007, INFORMED Magazine (a ZEISS publication) interviewed Bruce Gantz, MD, about trends and developments in skull base surgery. Dr. Gantz is the Professor and Head of the Department of Otolaryngology--Head and Neck Surgery and Brian F. McCabe Distinguished Chair in Otolaryngology--at the University of Iowa College of Medicine, and the University of Iowa Hospital and Clinics. Recognizing the rapid pace of technology advancements during the last decade, ZEISS sat down once more with Dr. Gantz to hear his thoughts on what has changed, and how innovations in microscope and visualization technologies may further impact surgical practice.

ZEISS: How has skull base surgery changed since we last spoke?

Gantz: "I am not certain it has changed dramatically over the last 20 years. We are more sophisticated on patient selection and monitoring: however, I do not see any new developments that alter the use of the microscope or the endoscope. Being more precise is important. Monitoring the cranial nerves to make sure we maintain hearing or facial function or also monitoring the vocal cords--this is making us more precise and less destructive."

ZEISS: The new KINEVO[R] 900 Robotic Visualization System[TM] from ZEISS combines optical and digital modalities and offers a book-marking function that allows surgeons to mark a location then come back to it later, which can help with monitoring.

Gantz: "I am sure there are a lot of new strategies, like the one you described, that will be helpful moving forward. Anything you can do to improve the ability to visualize will help us continue to achieve better outcomes. Skull base or cranial base surgery is one of the most complex areas of anatomy. Tumors that used to require large, open procedures can now be removed with minimally invasive techniques in some cases. But the surgery is delicate, and requires the closest cooperation among surgical disciplines to ensure a positive outcome for the patient."

ZEISS: Ten years ago, we saw a trend toward endoscopic procedures, and today endoscopic approaches have become much more commonplace. The QEVO[R] from ZEISS is a unique micro-inspection tool. It goes beyond the straight-line view of the surgical microscope to help surgeons visualize the missing critical information behind tissues.

Do you see other developments on the horizon, or a greater need for this type of microscopic visibility; do you see this evolving further?

Gantz: "I think endoscopic vision is extremely helpful ... with the microscope, we have excellent visualization except when you are obstructed and have to see around adjacent structures--an endoscope works great in those situations. There has been a trend recently where people are trying to do everything through the endoscope. I am not certain that this is where we will end up. I think it will be a compromise of a two-handed approach with a microscope augmented by the endoscope. The new system from ZEISS has an endoscopic tool in it. Integrating endoscopy and the microscope ... I think that is the future.

"I am sure the technology will continue to evolve. I don't primarily do endoscopic surgery because I like to use two hands, and I like the binocular vision that I can get with the microscope."

ZEISS: On the topic of digital visualization, there are systems that now allow the surgeon to see the main surgical view in 3D, facilitating working directly from a monitor. The ZEISS KINEVO 900 even offers this at a high, 4K resolution in addition to the optical view.

Do you think this digital visualization approach has the potential to benefit surgeries in the ENT space?

Gantz: "I am certain there can be benefits. If you learned skull base surgery by watching it on a screen, you could learn, though the learning curve is quite steep. Younger surgeons trained in endoscopic surgery and who are a part of the video generation are now more facile than those of us who worked only with the microscope. A digital hybrid solution, like the one ZEISS offers in the KINEVO 900, allows you to use it both digitally and then go back into the oculars in areas that are more sensitive. I think having both is a big advantage and I hope that ZEISS continues to develop that."

ZEISS: Are there other ways you see the digital visualization approach with 3D images and videos as well as other augmented visualization capabilities, like fluorescence, influencing ENT surgery?

Gantz: "Today we have far more digital images and visualization in the operating room. I think that the use of 3D imaging for modeling prior to doing the procedure could be very helpful--giving you a real-time, simulation feel. There are centers of excellence around the country that are developing simulation facilities that can do this.

"Right now, imaging strategies are really important. In fact, all types of imaging are important as we try to be more precise about what we do. If we could develop something specific for tissues, where the imaging could let you know if you are at the margin of the tumor or not, that would be wonderful."

ZEISS: What role do you think ZEISS plays in advancements for ENT surgery?

Gantz: "More than 50 years ago when the ZEISS microscope was first brought into the operating room, it was essential. It changed everything, and revolutionized the way we do skull base surgery and continues to evolve along with recent advances in otology and neurotology. Ever improving optics and illumination are making microscopic precision more the norm. I am certain that the microscope will always be there."

Dr. Gantz's team of neurotologists and neurosurgeons perform more than 100+ skull base cases per year.

Dr. Gantz is a noted specialist in the management of neurosensory or inner ear hearing loss, chronic ear disease, conductive hearing loss, balance disorders, facial nerve disorders and tumors of the cranial nerves. He has made major clinical contributions to skull base surgery, and his publications include more than 200 papers and contributions to 50 books and chapters. His current research interests include: cochlear implant clinical research, management of facial paralysis, hearing preservation in an acoustic tumor surgery and management of chronic otitis media with chloesteatoma. He has held major leadership roles in the establishment of the National Hearing Institute for Deafness and other communications disorders and is a member of the National Academy of Medicine.
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Author:Gantz, Bruce J.
Publication:Ear, Nose and Throat Journal
Article Type:Interview
Date:Dec 1, 2017
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