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The options for treating acoustic neuromas and other tumors of the skull base are a recent development of modern medicine. Though the related surgical procedures and radiotherapy techniques were first described years ago, many technical refinements have been developed over just the past 10 years.
In the early 1900's surgeons worked alone; the concept of a skull base "team" did not yet exist. Working at The Johns Hopkins Hospital, Harvey Cushing is recognized as the first to introduce the concept of a team approach to operative management of tumors of the nervous system in the first decade of the last century, emphasizing the need to simultaneously consider multiple systems and diverse therapies to achieve the best results (Goodrich J. A millennium review of skull base surgery. Childs Nerv Syst 2000, 16:669-85).
Building on the legacy of multispecialty approach to a challenging set of pathologies, The Johns Hopkins Center for Skull Base Surgery was founded in 1976.
The conceptual fathers were Dr. George T. Nager, world renowned authority on pathology of the temporal bone, then Chairman of Otolaryngology, and Dr. Donlin Long, then Chairman of Neurosurgery, who extended microsurgical skill to its fullest potential and brought multidimensional clinical experience to bear on treatment approaches. It was clear that the greatest advances could be made in this complex surgical area only by organizing overlapping specialties to make the most of their diverse skills.
This group of specialists has been organized in what has been termed since 1980, the Center of Expertise concept. In this organization centers are founded around highly specialized well-defined categories of disease.