Pacific Rim Master Class 2026: Advancing Skull Base Training Through Multidisciplinary Technique and Visualization

Inside the surgical education labs at the Pacific Neuroscience Institute, the 2026 Pacific Rim Master Class in Endoscopic Endonasal & Keyhole Surgery brought together neurosurgeons, fellows, and faculty from across the United States and internationally for an intensive, technique-driven program focused on complex skull base pathology. Developed in collaboration with the University of Colorado, the course emphasized a multidisciplinary approach to brain, skull base, and pituitary tumors through a combination of live case discussion, didactic sessions, and hands-on anatomical dissection.

The program opened with case-based discussions and live surgical commentary led by faculty including Daniel Kelly and Garni Barkhoudarian, setting the stage for a curriculum centered on procedural decision-making and operative strategy. Early sessions highlighted the importance of coordinated preoperative evaluation, with focused lectures on neuro-ophthalmologic and neuroendocrine workups, as well as sinonasal management in parasellar and pituitary tumors. These discussions reinforced the role of cross-specialty collaboration in optimizing patient outcomes in skull base surgery.

Across the weekend, the course explored a wide spectrum of keyhole and endoscopic approaches. Faculty-led sessions examined supraorbital eyebrow craniotomies, mini-pterional and transfalcine approaches, and keyhole strategies for aneurysms, posterior fossa lesions, and cavernomas. Parallel discussions addressed endoscopic transorbital techniques and their application to ventral skull base pathology, with comparisons to established approaches highlighting differences in surgical corridor, bone work, and resection capability.

A central component of the course was the extensive hands-on microdissection experience. Participants rotated through anatomical lab stations covering both open and endoscopic techniques, including transorbital eyelid approaches, supracerebellar infratentorial exposures, and endonasal sagittal and coronal plane dissections. These sessions emphasized spatial orientation, surgical sequencing, and the technical nuances required to safely navigate complex skull base anatomy.

One of the notable aspects of the lab experience was the integration of advanced visualization during high-risk scenario training, including carotid artery injury management. During these sessions, participants engaged with depth-enhanced imaging using the AED EndoPro 3D system, allowing for improved appreciation of critical neurovascular relationships within the confined endonasal corridor. The ability to visualize anatomical structures with enhanced depth perception contributed to a more intuitive understanding of instrument positioning and tissue handling during technically demanding portions of the dissection.

Additional sessions throughout the course addressed challenging clinical scenarios, including staged approaches to skull base tumors, multimodal management strategies, and complication avoidance. Discussions on sinonasal quality of life, olfaction preservation, and reconstruction techniques further underscored the importance of balancing aggressive resection with functional outcomes.

With a focused group of attendees and a high faculty-to-participant ratio, the course maintained an interactive environment that encouraged direct engagement at each station. This structure allowed participants to move beyond observation and actively refine their technical approach under expert guidance.

For participants and faculty alike, the Pacific Rim Master Class highlighted the continued evolution of skull base surgery through the integration of multidisciplinary expertise, advanced visualization, and hands-on technical training. As both endoscopic and keyhole approaches continue to expand, courses like this play a critical role in shaping the next generation of neurosurgical practice.

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