Training in Minimally Invasive Neurosurgery
Written by: Lindsay Doucette, Program Director
"It's good to be a seeker, but sooner or later you have to be a finder. And then it is well to give what you have found, a Gift into the world, for whoever will accept it." Richard Bach
Neurosurgeon Richard Moser and ENT Patricia Arteaga preparing for lectures on day one of the EETS course.
When doctors Hae-Dong Jho and Ricardo Carrau demonstrated the improved safety and effectiveness of endoscopic endonasal transsphenoidal surgery (EETS) in the late 1990s, it was a gift to innumerable patients around the world with pituitary tumors. Untreated, these tumors can cause significant hormonal dysfunctions as well as vision loss. EETS is a minimally-invasive procedure in which a neurosurgeon and an ear, nose, and throat (ENT) doctor navigate through the nostrils with an endoscopic camera to remove tumors from the pituitary gland and skull base. The procedure offers multiple benefits over previous methods of treating these tumors. Tumor removal often restores the patient’s vision and rebalances their hormones.
Solidarity Bridge has been instrumental in introducing this procedure at multiple sites across Bolivia and Paraguay. This year, the neurosurgical team at the Hospital Santa Bárbara in Sucre, Bolivia, asked the Neurosurgery and Neurology Institute (NNI) of Solidarity Bridge to provide training in EETS for their neurosurgeons and ENTs. In response, this past week, NNI president Dr. Richard Moser and our Bolivian ENT partner Dr. Patricia Arteaga collaborated to deliver a comprehensive theoretical and practical EETS course for eleven doctors in Sucre.
Dr. Arteaga learned this transnasal approach to pituitary tumor surgery from a Solidarity Bridge mission team nearly ten years ago. Since then, she has enthusiastically shared this gift with her Bolivian colleagues, both in her own practice in Santa Cruz and in collaboration with Solidarity Bridge teams expanding training throughout Bolivia and Paraguay. Dr. Arteaga is passionate about sharing her knowledge and expertise. In addition to taking time away from her practice to impart this course, she also designed styrofoam head models to use for endoscopic practice and 3-D instruction in nasal anatomy.
On the first day of last week’s course, Dr. Moser and Dr. Arteaga delivered theoretical lectures for the Sucre participants. They were honored to be joined for a brief lecture by the renowned surgeon Dr. Ricardo Carrau, whose Comprehensive Skull Base Surgery Program at Ohio State University (OSU) draws students from all over the world. Dr. Arteaga herself has participated in the OSU program, and through that connection Dr. Carrau agreed to share his academic materials with our partners in Sucre, joining them via Zoom.
Dr. Arteaga instructing course participants on manipulation of the endoscopic camera to access the location of pituitary tumors, using cadavers for realistic anatomy practice.
After the lectures, course participants had the opportunity to improve their hand-eye coordination with endoscopic instruments on Dr. Arteaga’s 3-D model. They also practiced using a neurosurgical drill on animal bone to compare how different drill bits produce different effects. Participants found it useful to practice on models before moving to the second day of the course which involved cadaveric dissection in the hospital’s gross anatomy amphitheater. There, Dr. Arteaga and Dr. Moser provided instruction on various transsphenoidal approaches using differing angled endoscopes. Course participants spent a full day in the amphitheater working with cadavers, learning about anatomy, and perfecting their endoscopic skills.
Dr. David Gardeazabal, director of the Neurosurgery Service at Hospital Santa Bárbara, was very pleased with the course. As a result of this learning experience and ongoing collaboration between the local hospital and the NNI, patients from southern Bolivia will one day have access to this minimally-invasive and highly-effective treatment for pituitary tumors. It was a joy for Dr. Moser and Dr. Arteaga to share this gift with their colleagues in Sucre. We are confident the gift will continue to be passed on in the spirit of inquiry and responsibility toward the common good.