Removal of Brain Tumors Using Minimally Invasive Endoscopic Approaches

Surgical removal or resection of pituitary brain tumors has evolved from intra-cranial or “open” approaches. Because of the higher mortality rate of the intra-cranial techniques, Neurosurgeons sought for better alternatives, turning into extra-cranial routes in the treatment of these specialty-related diseases. The most common is the transphenoidal approach, typically done with the use of a 0º or 30º endoscope (like a tiny camera) and intra-operative image neuronavigation guidance systems (like a GPS for the brain), where the Neurosurgeon is able to remove tumors, most often pituitary tumors (hypophisis), by making tiny incisions through the nasal and sinus cavities.

Endoscopic resection is associated with significant benefits over older “open” approaches that removed and cut directly into the skull requiring patients to shave their head and surgeons having to rebuild the skull after surgery.  Benefits include improved operative visualization versus the “open” approach (up to 43% of patients have residual fragments or pieces of tumor via the old method), reduced time on the operating table, reduced hospital stay from weeks to days, reduced functional impairment and overall cosmetic satisfaction.  Patients do not have any visible scarring using this minimally invasive approach.

Additionally, uninvolved adjacent structures are less damaged by endoscopic surgery. Patients operated on endoscopically require a shorter follow up period and the technique is suitable for patients who are not medically fit to undergo “open” procedures as well as for pediatric patients.

View of the endoscope reaching the pituitary tumor (pictured in green) via the sinus cavity (pictured in pink)

Actual endoscopic view of a pituitary tumor resection