OLD ANATOMY NEW TECHNIQUES

Using state of the art tools, Macquarie University Hospital neurosurgeons have taught the white matter dissection technique in Australia for the first time as part of their advanced training series.

In mid-June, Associate Professor Antonio Di Ieva, who holds a joint appointment in both neuroanatomy and neurosurgery at MQ Health, ran the Hospital’s first ‘white matter dissection’ workshop, also bringing this specific technique to Australia for the first time.

White matter dissection – known as the Klingler technique – was first introduced in Switzerland about 70 years ago, and was later revived in Europe and the US in the 1990s. The technique is now widely considered internationally to be an important component of standard brain anatomy study, above all in the neurosurgical field.

The RACS OPD-approved activity took place at Macquarie University Hospital in June and was designed for registrars, surgeons and consultants to improve their understanding of neuroanatomy and brain tumour resection.

“There is nothing more important for a neurosurgeon to master than a deep understanding of neuroanatomy,” said Associate Professor Di Ieva, who received his PhD from the Medical University of Vienna and has held positions as a consultant, researcher, lecturer and professor at major neurosurgery and neuroanatomy centres and universities across Europe and in Canada.

“The schematic understanding of connections in neuroanatomy that is gained during medical school is the skeleton upon which substance must be built as a neurosurgeon.
“To this end, the complex structures of the brain can be much better understood when the delicate fibres of white matter are dissected. Internationally, white matter dissection is now regarded as better than other anatomical techniques in understanding the brain, and is part of the armamentarium of several neurosurgeons worldwide.

“Our training at Macquarie University Hospital aimed to bring Australia into line with international best practice, by providing advanced training through three-dimensional visualisation of the brain connections as applied in vitro, in vivo and on neuroimaging.

“For surgeons, the training will allow them to perform more accurate dissections of brain tumours and brain surgery in general. For specialists and physicians, the knowledge will help enormously with better diagnosing of brain lesions by enhanced understanding a brain MRI – above all, modern MRI sequences aimed at visualising brain white matter, such as Diffusion Tensor Imaging.”

The Brain Anatomy and White Matter Dissection Workshop saw 18 participants – including neurosurgery consultants from China, New Zealand and South Africa – in the two-day workshop experiencing 3D visualisation of white matter connections, along with lectures and hands-on training in performing the technique on human brain specimens.

Associate Professor Di Ieva used cutting-edge neurosurgery visualisation technologies, including the Synaptive robotic system of visualisation and the Storz 3D exoscope – at the time, the only 3D exoscope in the world.

“When I was a completing my fellowships overseas, I organised several of these lectures and workshops in Europe and Canada,” he said. “I am pleased to be bringing this advanced training to MQ Health as part of my dual expertise in neurosurgery and neuroanatomy, and as part of MQ Health’s commitment to advanced training for doctors.”

A second training activity – the 2nd Macquarie Neurosurgery Micro-Vascular Anastomosis Workshop – was held on day three of the initiative. This one-day training saw Professors Stoodley, Assaad and Davidson teach microvascular anastomosis to eight national participants.

Participants learned state-of-the-art bypass surgery techniques, indications for revascularisation surgery, microsurgical techniques for microvascular anastomosis, and complications and outcomes of bypass surgery. Morning lectures were followed by hands-on training in performing end-to-end and side-to-side anastomoses on realistic biomodels, making the use of animal models unnecessary and avoiding the sacrifice of any animals, as usually happens in other similar workshops.
The one-day workshop following the 2015 Inaugural Macquarie Neurosurgery Micro-Vascular Anastomosis Workshop, which was presented by the world-renowned Professor Michael Morgan.
This year’s training was made possible with support from Aesculap Academy Australia and sponsorship by B. Braun, Zeiss, Synaptive and Karl Storz.

 

ABOUT ASSOCIATE PROFESOSR DI IEVA:

Associate Professor Di Ieva has published more than 100 scholarly articles and several book chapters on brain anatomy and neurosurgery and is the recipient of five international awards for neurosurgery and neurosciences. He is the main author and editor of the Handbook of Skull Base Surgery, published in 2015 and now one of the most widely used books in the field. Moreover, he edited the only book in the field about the application of computational fractal-based analysis into the neurosciences, The Fractal Geometry of the Brain.