In Minimally Invasive Brain Tumor Surgery, Experience Counts

As endoscopic endonasal surgery developed over the past two decades, it became recognized that the procedures required a steep learning curve. Patient outcomes were known to improve as a surgeon continued to perfect the techniques, after which that surgeon was considered to have achieved mastery. A recent paper published by Dr. Theodore Schwartz and his team has established that outcomes continue to improve over time, as surgeons hone the advanced skills required for these demanding procedures. Surgeons with the most experience with these procedures continue to produce superior outcomes for their patients.

The new paper, “How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases,” is the largest study ever published that looked at long-term improvements in outcomes for minimally invasive tumor surgery. To eliminate bias from the known initial learning curve, the authors excluded the first 200 cases and looked only at the next 1,000 procedures performed by the senior authors at NewYork-Presbyterian/Weill Cornell Medical Center. Outcomes of the first 500 of those cases were compared with outcomes of the second 500 to see if results continued to improve with additional surgical experience.

The results showed that the second, later group was more likely to have achieved gross total resection, with a decreased need for lumbar drains, than the earlier one, even though mean tumor size was the same for both. Complication rates were low for both groups.

“The data confirms what we believed to be the case from our experience,” notes Dr. Schwartz. “Brain tumor patients do better the more experience their neurosurgeons have with minimally invasive techniques – and that benefit doesn’t stop after the early learning curve. Patients should be aware of this when they search for a surgeon and look for one with significant experience, over decades, in order to get the best outcomes.”

The article was written by Iyan Younus of the Weill Graduate School of Medical Sciences; in addition to Dr. Schwartz it was co-authored by Drs. Abtin Tabaee, Jeffrey P. Greenfield, Ashutosh Kacker, Vijay K. Anand, Peter Morgenstern, Rafael Uribe-Cardenas, and Mina Gerges; and Mahmoud Eljalby of Weill Cornell Medical College.

The study concludes that “contrary to popular belief, the surgical learning curve does not plateau but can continue for several years.”  At the Weill Cornell Medicine Brain and Spine Center, with decades of leadership on these endoscopic procedures, our neurosurgeons are highly experienced and continue to perform hundreds of these surgeries each year.

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