Teamwork in skull base surgery: An avenue for improvement in patient care

Abstract

Background:During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges.Methods:Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: “teamwork”, “multidisciplinary”, “interdisciplinary”, “surgery”, “skull base”, “neurosurgery”, “tumor”, and “outcome”.Results:Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support.Conclusions:Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise.

Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?

“…20 The multidisciplinary team approach between the otolaryngologist and the neurosurgeon improves the postoperative quality of care in their respective inpatient services and outpatient clinics. 21 Advanced knowledge and the development of skull base surgery have resulted in better surgical access with minimal brain retraction and minimized vascular injury. Unlike with the transcranial route for the management of anterior skull base lesions, the risk of postoperative seizure is an exceedingly rare complication in EETS.…”

Minimally invasive surgery of the anterior skull base: transorbital approaches

“…Those authors argue that an interdisciplinary cooperation has important advantages for all aspects of the treatment of patients with skull base diseases, including the clinical diagnosis, imaging, invasive diagnostics, and especially for the selection and performance of the necessary therapeutic modalities. The authors recommend a structured and formalized process for establishing and managing an interdisciplinary team [ 67 ]. Specific data on the management of minimally invasive approaches are not available up to now.…”

Integrated Anterior, Central, and Posterior Skull Base Unit – A New Perspective

“…The two members of this team include the neurosurgeon and the ENT surgeon. Their mutual support of each other is essential for success ( 1 ). Traditionally from an otolaryngologist’s point of view, rhinologists perform anterior skull base surgery while otologists perform the approaches to the lateral skull base.…”