Department of Otolaryngology-HNS University of California, Irvine 101 The City Drive South Building 56, Ste. 500 Orange, CA 92868-3201

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Registration Form
Complete, tear off, and mail to address at bottom

Name:____________________________________________ Degree:____________

Specialty: Otolaryngology-HNS Neurosurgery Other:__________________

Address:_______________________________________________________________

City:___________________ State:_________ Zip code:_______________________

Daytime Phone:__________________ Fax:__________________

Email:__________________________

For CME registration purposes, please supply either the last 5 digits of social security number or your medical license number: ___________ (Mandatory)

Course Attendance Rates: Faculty Residents

Lecture, Prosection demonstrations, Cadaver lab $1000 $750 Lecture, Prosection demonstrations $350 $150

Make check payable to “UC Regents”. In memo section, please state “2006 endoscopic skull base course”. Residents will need a letter from their program director or department chair verifying resident or fellow status.

Credit card payment: ___Visa ___Master Card ___Discover ___American Express

Name on card:______________________ Signature:_______________________ Card number:______________________ Expiration date:__________________

Cancellations: Cancellations received in writing before June 1, 2006 will be refunded less a $75 administrative fee.

Please mail form or FAX to:

Department of Otolaryngology-HNS University of California, Irvine Attn: Ellen Takahashi 101 The City Drive S., Bldg. 56 Ste 500 Orange, CA 92868-3201 FAX: (714) 456-5747 TEL: (714) 456-5753 Ellen Takahashi or Mary Evans Email: eatakaha@uci.edu Additional details including course agenda can be found at:

http://www.ucihs.uci.edu/otohns/

The University of California, Irvine and Medical University of Graz in 2005 initiated an educational collaboration to promote international, interdisciplinary clinical exchange, and scientific research.

The University of California Irvine, School of Medicine gratefully acknowledges the educational grants provided by Karl Storz Endoscopy-America, Inc., Arthrocare, Inc., GE Medical Inc., Medtronic Inc., and Intuitive Surgical Inc.

Advanced Endoscopic Surgery of the Skull Base and Paranasal Sinuses
Presented by the Department of Otolaryngology-Head and
Neck Surgery The University of California, Irvine

Course Directors: Distinguished Guest Faculty:
William B. Armstrong, M.D.
Quoc A. Nguyen, M.D. Medical University of Graz
Heinz Stammberger, M.D.
UC Irvine Faculty Hannes Braun, M.D., Ph.D.
Roger L. Crumley, M.D., M.B.A. Michael Mokry, M.D.
Anton H. Hasso, M.D.
Mark Linskey, M.D. University of Southern California
Chiedozie Nwagwu, M.D. Dale H. Rice, M.D.
So. Cal. Permanente Medical Group
David Keschner, M.D.
Target Audience

The course is designed for Otolaryngologists and Neurosurgeons interested in developing endoscopic surgical techniques in the anterior skull base, and disseminate knowledge of new advanced endoscopic surgical procedures.

Brief Course Description This two-day course is a combined lecture and lab dissection experience. Morning sessions (8-12 AM) consist of lectures, discussions, and videos. Afternoon lab sessions (1-5PM) will focus on prosection demonstrations and anatomical dissections. Two attendees are assigned per dissection station, one anatomic specimen per station per day. Exposure to 3-D surgical navigation systems will be provided in the lab sessions. Please see our website www.ucihs.uci.edu/otohns/ for additional details.

Course Objectives:
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Increase surgical confidence and expansion of your surgical repertoire.
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Demonstrate radiographic abnormalities in the paranasal sinus region resulting from benign and malignant neoplasms in the paranasal sinuses and identify involvement of critical anatomic structures.
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Assess and compare endoscopic medial maxillectomy with your existing surgical skills to perform endoscopic medial maxillectomy.
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Assess and compare endoscopic exposure of the pituitary fossa with standard approaches and integrate this experience with your existing surgical skills to perform endoscopic surgical approach to the pituitary fossa with your neurosurgery colleague.
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Incorporate the use of 3-D navigation technology into your surgical practice for appropriate cases that would benefit from use of surgical navigation equipment.

Accreditation Statement: The University of California, Irvine School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement: The University of California, Irvine School of Medicine designates this educational activity for a maximum of 14 hours AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Statement: It is the policy of the University of California, Irvine School of Medicine and the University of California CME Consortium to ensure balance, independence, objectivity, and scientific rigor in all CME activities. Full disclosure will be made in writing via the handout materials (syllabus/flyer).

Americans with Disabilities: The University of California Irvine, School of Medicine complies with the Americans with Disabilities Act. Please contact Ellen Takahashi at (714) 456-5753 or eatakaha@uci.edu no later than June 1, 2006 and every reasonable effort will be made to accommodate your special needs.