North American Skull Base Society 26th Annual Meeting: Innovation and Creativity in Skull Base Surgery

If you always do what you always did, you will always get what you always got.

—Albert Einstein

Surgery has been likened to a musical performance.[1] It is no coincidence that the ancient Greeks attributed both medicine and music to the God, Apollo. In particular, surgery is like jazz music, requiring a great deal of improvisation. This is one of the aspects of surgery that is most appealing—every case is different and deviates from the script to some degree. Just like music, surgical improvisation occurs on a continuum from interpretation (taking minor liberties) to embellishment (rephrased but recognizable) to variation (introducing new elements) to improvisation (little resemblance to the original). This presentation will attempt to answer questions about innovation in surgery and the creative process.

During my career, I have witnessed profound changes in the practice of skull base surgery. The evolution of skull base surgery can be divided into periods characterized by different surgical principles ([Table 1]). Each period represents a paradigm shift that follows a typical cycle of adoption[2] from early innovators to laggards until a new standard is established and the cycle repeats itself. Much like the grieving process, there is an emotional progression from denial, anger, and fear to eventual acceptance, enthusiasm, and ownership. Following a technology trigger, expectations often exceed the reality. A peak of inflated expectations is followed by a trough of disillusionment before proceeding up a slope of enlightenment to a plateau of productivity.[3]

Table 1 Evolution of skull base surgery

Period	Principles
1970s	Exploratory phase
1980s	Open cranial base surgery
1990s	Endoscopic pituitary surgery; keyhole surgery; radiosurgery
2000s	Endoscopic endonasal cranial base surgery
2010s	Multiport surgery; functional EES

Abbreviation: EES, endoscopic endonasal surgery.

• References

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• 3 Interpreting technology hype. Gartner Hype cycle. Available at: http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp . Accessed February 12, 2016
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• 12 Dunning–Kruger effect . Available at: https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect . Accessed February 12, 2016
• 13 Lewis S. The Rise. New York, NY: Simon & Schuster; 2014
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• 16 Wang Y, Kotsis SV, Chung KC. Applying the concepts of innovation strategies to plastic surgery. Plast Reconstr Surg 2013; 132 (2) 483-490