Duration of fellowship: 1 year
Institution of fellowship: House Institute Foundation
Fellowship Director: Gregory Lekovic, MD, PhD
Goals of fellowship:
The goals of this one-year fellowship will be to gain a broad experience in the diagnosis and management of skull base pathologies with particular emphasis on lateral skull base.
Multiple learning opportunities will be provided, including
- clinical instruction
- laboratory dissection
- didactic learning
- independent research.
Anticipated fellow schedule/ weekly curriculum:
- 3 days a week operative experiences
- 1 day a week skull base dissection lab
- 1 day a week academic activities and/ or outpatient clinic
- Cover call for operative patients
The clinical exposure of the fellow will include the diagnosis, surgical, medical, and radiosurgical management of patients with acoustic neuroma, meningioma, glomus tumor, and related skull base pathologies.
The anticipated operative exposure will consist of surgical assisting or observation of approximately 120 skull base cases over the course of the year. In addition to the standard translabyrinthine, middle fossa, and retrosigmoid approaches for acoustic neuroma, the fellow will gain clinical and/ or laboratory dissection experience in less commonly skull base approaches/ procedures including, but not limited to:
- Auditory brainstem implantation
- retrolabyrinthine approach
- trans-otic and trans-cochlear approaches
- extended middle fossa (ie Kawase)
- combined petrosal approaches;
- Fisch A, B and C/ transjugular approaches to the infratemporal fossa
- far lateral/ transcondylar apoproach and modifications
- anterior skull base approaches, including orbitozygomatic and endoscopic transsphenoidal and transtubercular approaches
Thus, the fellow is expected to develop a “360 degree” understanding of approaches to the skull base. The fellow is also invited to participate in radiosurgery cases that are performed at the Pasadena Cyberknife center, with a typical volume of 2-4 cases per month.
Responsibilities include surgical assisting in surgery and routine post-operative care. The resident fellow will also be expected to participate in the care of general neurosurgery patients on our service, including weekend rounding etc.
Skull base laboratory dissection
The House Ear Institute skull base dissection laboratory will provide ample occasion for the fellow to learn key skull base approaches described above. Both temporal bones and whole cadaver heads will be provided. Opportunities for structured, didactic temporal bone drilling will be provided by House Clinic neurotology staff and/or fellows. Additional laboratory exposure is available at the Providence Neuroscience Institute Skull Base Laboratory in Santa Monica, CA.
Skull base laboratory dissection resources:
- Lateral Skull Base Surgery: The House Clinic Atlas
- House Ear Institute Temporal Bone Dissection Manual
Didactic learning opportunities consist primarily of educational conferences including:
- Grand Rounds (lecture format), every other Friday AM
- Neuro-otology radiology rounds, Friday AM (alternating with Grand Rounds)
- Neurofibromatosis Type 2 Tumor board
- Neuro-oncology tumor board
The fellow will present at Grand Rounds at least once during the year, preferably presenting their own independent research.
The fellow will be expected to complete and submit scholarly work to national conferences and journals for publication.