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Surgeons Remove Giant Brain Tumor With New, Minimally Invasive Technique

(Mar 1, 2009)

When a 50-year-old man began to lose his sight, became increasingly weak, then collapsed early last year, he was taken to the local emergency room. Doctors there discovered a tumor on his pituitary gland the size of a tangerine. The growth was benign but was pressing on his optic nerve and encroaching on other parts of his brain. Surgeons were able to remove part of the tumor, but the patient's condition deteriorated. He contacted neurosurgeons at several major hospitals in a search for one who would be willing to try to remove the remaining tumor endoscopically. Each doctor he spoke to told him this approach was impossible, that it would be necessary to remove the tumor by opening up his skull. Then, through the internet, he found Theodore Schwartz, MD, and Vijay K. Anand, MD.

Endoscopic Skull Base Surgery: A Collaboration Between Neurosurgery and ENT

Dr. Schwartz, a neurosurgeon, and Dr. Anand, an otolaryngologist work as a team at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and each year perform 50 to 60 minimally invasive surgeries on the skull base, the complex area of the brain behind the face where the pituitary gland is located. Drs. Schwartz and Anand studied this patient's medical records, told him they would be able to get his tumor out, and after he flew to New York they removed the growth through his nose. Two weeks after the operation he was back on his feet, his vision was returning, and now, a year later, he is fully recovered.

Endoscopic endonasal neurosurgery – procedures in which surgeons operate on the brain through the nose – are becoming increasingly common. During this type of surgery doctors use long, rigid or flexible tubes tipped with cameras and miniaturized surgical tools. The nasal passages provide a direct route to the skull base, where several different types of tumor originate. Tumors of the pituitary gland, the third most common type of adult brain tumor, are the most common skull base tumor.

Advantages of Endoscopic Skull Base Surgery Over Open Surgery

"Minimally invasive surgery has been a real revolution in the way we perform pituitary and skull base surgery, and it has many benefits," said Dr. Schwartz. "In traditional skull base surgery you have to open up the scalp and the head, move the brain aside, and manipulate the many nerves and arteries that are in the way to remove a tumor that sits at the very base of the skull – all of which can result in complications. Going through the nose is more direct. The endoscope allows us to get a beautiful visualization of the anatomy of the base of the skull and the midline of the brain. Patients tolerate this better and go home sooner."

Unlike most surgeons who perform endonasal surgery, Drs. Anand and Schwartz can maneuver their instruments to the site of the problem without removing parts of the septum, the partition between the two sides of the nose, and turbinate, shelf-like bones that project into the nasal passageways. This leaves patients in better shape after the operation and without the ongoing complications that can ensue when these structures are altered during surgery, said Dr. Anand.

Outlook for Endoscopic Skull Base Surgery

Drs. Schwartz and Anand continue to improve their endonasal procedures. They are working to develop:

  • Better imaging techniques such as a 3D endoscope and monitor to improve their view of the tumor and CT scans and fluoroscopy to help them gauge their progress during the operation.
  • Improved techniques to reconstruct the skull base to prevent the leakage of cerebrospinal fluid following the operation.

Dr. Schwartz concluded, "Minimally invasive endoscopic surgery is the state of the art. We are pushing the frontiers even farther and maximizing what we can do."

Contributing faculty for this article:

Theodore H. Schwartz, MD is an Associate Attending Neurosurgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Associate Professor of Neurological Surgery, Surgical Director of the Comprehensive Epilepsy Center, and Co-director of the Institute for Minimally Invasive Skull Base Surgery at Weill Cornell Medical College

Vijay K. Anand, MD is an Attending Otolaryngologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Clinical Professor of Otolaryngology and Co-director of the Institute for Minimally Invasive Skull Base Surgery at Weill Cornell Medical College

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