Rhinology/Skull Base Surgery
Macquarie University Hospital is fortunate to have a highly skilled skull base surgical team who can perform common skull base tumour surgery to address meningioma, pituitary tumours, craniopharyngiomas and chordomas. In addition, Macquarie University Hospital provides endoscopic approaches to some vascular lesions and the latest management of nose and sinus tumours. Skull base surgery is a dynamic subspecialty and the last decade has also witnessed the application of endoscopic techniques to the ventral skull base using an endonasal corridor. Our surgeons have been part of the transition from external approaches to the endonasal corridor, which has seen significant improvements in patient outcomes.
We are also able to offer patients novel treatment using topical therapies. With a strong research program in topical therapies behind them, Macquarie University Hospital specialists can offer many patients with Chronic Respiratory Syndrome (CRS) a non-surgical means of controlling their condition.
Our research – through links to the Faculty of Medicine and Health Sciences – has focused on the management of certain pathologies, endoscopic access to various areas on the skull base, and reconstruction of the defect, ensuring that clear anatomical landmarks can be identified during surgery and improving quality of life and function after treatment. The focus of surgical treatment in rhinological conditions is always to control disease and cure patients; however, we continue to make efforts to reduce the impact of the therapies we use. A priority of surgery is not just on reducing recovery time and peri-operative morbidity, but also on decreasing the long-term impact of having a tumour removed. Retaining good nose and sinus function from the area in which the tumour was located is a secondary but critical endpoint.
The rhinology and skull base research program has a focus on defining the role of epithelial mediated eosinophillic inflammation in CRS. Understanding the pathophysiology of why patients develop chronic inflammatory disease in the sinuses – often persisting well after bacteria have been removed – has dramatically changed in the past decade. One key area of research is looking at the interaction between the innate and adaptive immune systems that maintain a homeostasis to the mucosal surface. Epithelial derived cytokines (IL25 and IL33) have been linked to underlying eosinphillia in CRS patients where the same is not true for TSLP, a mediator not exclusively produced from the epithelium. There is growing acknowledgement of the presence of innate non-B, non-T immune cells that may possess the ability to develop into local tissue eosinophilia in inflammatory airway disease. The mechanism of activation of these cells is a focus for future work by our group.
Defining CRS sub-populations, or endotypes, that may benefit from specific novel topical therapies and avoid the need for multiple sinus surgeries has been very successful in recent years. The DHM Pathology department has assisted our researchers in establishing a unique reporting system that identifies these sub-groups. This system has been subsequently used in the US and Canada. The novel delivery of topical steroid to the paranasal sinuses is an important research focus at the Faculty of Medicine and Health Sciences. The increased distribution of anti-inflammatory agents to the sinuses has been associated with a dramatic increase in the clinical success of managing patients with chronic rhinosinusitis. Along with research into alternative or adjunct topical agents, such as antiobiotics, we are now able to offer patients a 90 per cent success of controlling their condition with simple topical therapies and thus avoid systemic therapies or multiple surgeries.