Global nod for UM surgeon’s atlas

Labour of love: It took Prof Prepageran four years to co-author the book, which covers the entire range of skull base surgery.

AN ear, nose and throat (ENT) surgeon who is also an academic at Universiti Malaya (UM) Medicine Faculty, Prof Datuk Dr Prepageran Narayanan is well known for his passion for treating patients, as well as teaching medical students and ENT fellows.

His expertise is so sought after that his surgical teaching videos, which were posted on UM otorhinolaryngology department’s specialised YouTube channel for surgical education, have received overwhelming response, with a dissection video garnering over 214,000 views.

Over the years, he had received multiple requests from young surgeons to pen his experience of performing the entire range of skull base surgery.

This gradually gave him the impetus to produce a book on the subject, which has recently gained global recognition with its launch by Thieme, an award-winning international medical and science publisher.

Titled Atlas of 360 Degree Skull Base Surgery, the book was co-authored by Prof Prepageran and Dr Narayan Jayashankar from India, with contributions from UM’s otorhinolaryngology and neurosurgery departments, as well as experts from Oxford University, Harvard University and the Ohio State University.

“It is not a dry textbook but a comprehensive skull base surgical manual of how these complicated surgeries are done step by step,” the UM senior professor and consultant otorhinolaryngologist told StarEdu.

He explained that skull base surgery involves the removal of lesions from the area under the brain filled with many nerves and blood vessels.

“Traditionally, it is usually performed by three separate ENT teams involving a rhinologist who performs the minimally invasive transnasal endoscopic approach, a neurotologist who performs the posterolateral approach, and a head and neck surgeon who performs the open skull base approach,” he said.

On what sets this book apart from others in the field, he said: “The two main authors and editors of this atlas perform these three approaches, which makes this atlas one of the few books covering the entire range of skull base surgery by the same authors.”

Prof Prepageran shared that the book production involved a multidisciplinary collaborative effort between various UM departments, with the ENT surgeries in the atlas from Malaysia supervised by him at UM medical centre and those requiring neurosurgery jointly performed with UM consultant neurosurgeon Prof Dr Vickneswaran Mathaneswaran.

“All the specialists in my department were involved in writing the chapters, including three fellows who were training with us at that time from Switzerland and the United Kingdom,” he said.

Revealing that the book took four years to complete, Prof Prepageran shared that during his international travels to give lectures about these surgeries, he received comments that many surgeons wanted different books on skull base surgery to be summarised into one complete surgical manual.

“This book being used as a surgical atlas worldwide is an endorsement and recognition that Malaysia and UM are now in the forefront of surgery and surgical training.“We have come to a level where our experts can host international meetings and write international surgical manuals,” he said.

Prof Prepageran himself has shared his surgical knowledge via workshops, surgeries, live dissections and lectures across continents with leading roles in international committees and editorial boards.

This is not the first book he has produced as Prof Prepageran has authored multiple books and dissection manuals, and written over 200 peer-reviewed publications.

Advocating for the revolution of ENT fellowship programmes worldwide, he said there is a need to train all-rounders in skull base, instead of solely sub-specialising fellows in one of the three traditional divisions.

“The younger generation are so versatile and skilful. With a proper fellowship training programme complemented with materials online, it is so much easier for them to learn and train nowadays.

“Here in UM, our fellowship programme trains surgeons to be well adept at the surgical skills and techniques employed across all subspecialties,” he said, adding that he has mentored over 50 surgeons in 360-degree skull base surgery since 2006 at UM.

As the first fellow trained by Prof Prepageran, Assoc Prof Dr Tengku Ahmad Shahrizal Tengku Datuk Omar, who is the current UM Medicine Faculty deputy dean of student affairs and was the head of department when the book was being written, applauded Prof Prepageran’s effort, while describing his passion for treating and teaching as legendary among fellows and students.

“With his international reputation as one of the world’s top skull base surgeons, and having performed more than 270 live surgeries to a global audience and more than 750 presentations locally and internationally, Prof Prepageran remains a simple person, who is also one of the humblest people I have ever known,” he said.

Prof Prepageran’s philosophy as a surgeon is that medicine is not just about healing, but also about teaching young surgeons how to heal.

“I hope that the publication of this atlas will serve as a testament that there is no reason why while working in Malaysia, one cannot produce work that is internationally recognised.

“Knowledge not passed on is knowledge wasted. Let what we have done be the basis for the younger generation to build on and achieve even further,” he said.

Featuring a total of 76 chapters in 1,036 pages with different clinical cases, detailed descriptions of surgical approaches and 2,907 high-definition photographs, the atlas was independently reviewed by United States neurosurgeon Dr Rima Sestokas Rindler in the renowned journal Operative Neurosurgery.

Prof Prepageran has been appointed the incoming president of the Asia Pacific Symposium on Cochlear Implants and Related Sciences 2025 and the first Asian president of the 9th World Congress for Endoscopic Surgery of the Paranasal Sinuses, Skull Base, Brain and Spine 2024.

Zhi Yong, 22, a medical student at Universiti Malaya, is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. To join Star-NiE’s online youth community, go to facebook.com/niebrats.