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The Benefits of Endoscopic Brain Surgery
Tumors of the skull base are not totally uncommon. And when patients are stricken with this tumors and it’s often very traumatic because in general the only approach to get to a tumor in the nasal cavity or the base of the brain is through large incisions on the face those lead to scarring and often times functional deficits in terms of vision and the ability to smell and chew.
What we’ve been doing in Mount Sinai for the 10 maybe 12 years now is endoscopic nasal approach to the skull base. And so what we do is we work with our neurosurgical team as part of the skull based team accessing the base of the brain not through a craniotomy where there’s an incision made on the top of the head the skin is pealed down, the skull is removed and the brain is pushed back. Instead we access it through the base of the brain through the nose.
So my partners in neurosurgery and I each handle an endoscope. It goes through the nostril and instead of making the craniotomy or opening to the brain up here we make it through the nose. There are several advantages to that. First of all the conventional approach requires pulling the brain back and when you do that, you can suffer swelling in the brain and that’s particularly devastating to an older patient. That swelling can lead to cognitive problems and functional problems that can be permanent.
When you go through the nose there’s no incisions at all on the face or the skull and there’s no incisions on the scalp. And most importantly there is no retraction of the brain so there’s no swelling. In particular young patients and old patients tolerate this procedure exceptionally well. Instead of being left in the neurosurgical intensive care unit for four or five day’s monitored very carefully these patients typically go home in two days with nasal packing. Because they don’t require any retraction of the brain they very seldom have any cognitive or any functional deficit at all.
So it’s really been a wonderful advance for medicine in surgery to be able to access the base of the brain from underneath using two endoscopes in a collaborative approach with our neurosurgical colleagues.
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