2018 Travelling Fellowship Report
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University of Insubria, Varese/Piacenza

Stephen Ball

Many thanks to the British Rhinological Society for the generous fellowship award to visit Professor Paolo Castelnuovo & Professor Mario Sanna’s institutions in Northern Italy. This has been an absolutely fantastic training experience and I am very grateful to both Professor Castelnuovo, Professor Sanna and their great teams for letting me join their respective departments.

The fellowship period began with the three day Varese advanced skull base course. The course starts each day at 7 am with surgical case presentations of the day in English where clinical history, investigations and imaging were discussed. This was then followed by a one hour lecture such as endoscopic surgical anatomy of the skull base, multiportal approaches to the skull base or management of skull base complications before four hours of live surgery and debate.

Live surgery sessions were arranged as a video (endoscopic, open, imaging & navigation views) and audio link up to the operating rooms with expert faculty present in the seminar room and direct communication throughout with the operating surgeons. The surgery was of course in real time with lots of honest debate about surgical tips, potential pitfalls and alternative approaches. The cases shown were advanced such as; Draf III & centripetal ethmoidectomy with trans cribriform skull base and dura resection plus duraplasty for carcinoma; sarcoma of Meckels cave via endoscopic trans pterygoid and infratemporal fossa resection for example. There were also some simpler cases such as complicated FESS revision with sampters triad after multiple previous surgeries in other units. Regardless of the complexity of the cases the live surgery sessions went through a logical stepwise approach to help build a structure for the participant to replicate in the lab or potentially their own practice.

The laboratory sessions were from lunchtime to 7pm with excellent advanced surgical kit as per their operating rooms and a high faculty to participant ratio. For each of the advanced skull base approaches we were fist shown a video demonstrating the dissection along with tips and tricks from the faculty. We then replicated each of these with supervision and tuition from the combined ENT/Neurosurgery faculty.

The course was completed by sitting the final examination & post graduate diploma in advanced endoscopic skull base surgery of the University of Insubria in Varese. This was a single best answer format of anatomical and clinical surgery relevant to the techniques used in the course, so as long as you completed the course and appropriate study you would be expected to pass this and gain the certificate.

Following the course I stayed in the department for a pre arranged short fellowship where each day they have the surgical cases presentation in the morning and then can go to the operating room all day into the evening. This was an excellent experience to directly see how the team in Varese manage their patients. The team were really very welcoming and incorporated me into their daily activities and each surgical case was like a tutorial with plenty of time to discuss throughout and afterwards. The combination of the course, exam and short fellowship worked really well and I would highly recommend it.

Following my visit to Professor Castelnuovo’s unit I spent a short period to return to Professor Mario Sanna’s Otology and lateral skull base surgery unit in Piacenza, which is only a short train ride away - approximately 2 hours. There I spent the time in theatre for a range of skull base cases such as translabyrinthine vestibular schwannoma resections, petrosectomy for tumour, stapes surgery and advanced CSOM/cholesteatoma work for example. Here as in Varese they welcomed you as part of the team and discussed throughout the operations all of which were on a monitor in the operating room for teaching purposes. I have picked up a number of surgical tips and tricks that I will incorporate into my own practice.

This has been an excellent training opportunity that I thank both units for allowing me to attend and also the BRS for supporting. From each institution I have learned a range of anatomical, surgical, academic and non-technical skills for how they look after their patients and their team. In both places I was struck by how open and friendly they were to collaborate and pass on their knowledge. These experiences were as important as the technical surgical training. I look forward to taking up the invitation to return in the future and will ideally do so with a neurosurgical colleague where possible. Many thanks for the opportunity!

Stephen Ball

University of Insubria

University of Insubria, Varese/Piacenza

Varese & Ospedale di Circolo e Fondazione Macchi
The team at Varese
The team at Varese
The team at Varese
A weekend market in Varese
Some of Professor Castelnuovo’s many tips for understanding the anatomical dissection – branches of the internal maxillary artery & ethmoidal arteries
Some of Professor Castelnuovo’s many tips for understanding the anatomical dissection – branches of the internal maxillary artery & ethmoidal arteries

Contact details for the institutions:
Prof Paolo Castelnuovo

Prof Mario Sanna