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Minimally invasive endoscopy for treatment of complex brain tumors

Roukoz B. Chamoun, MD, neurosurgeon

chamoun-roukoz-BWP000AAThanks to quickly evolving technology and practice, many skull-base and intraventricular tumors thought to be inaccessible or highly risky for surgical candidates can now be biopsied, precisely irradiated or removed with far fewer potential deficits.

Neurosurgeons at The University of Kansas Hospital have been using endoscopy to address such tumors since the summer of 2012. While most states have just one or two centers that are experienced in this area, we are the only hospital in the Kansas City region with surgeons trained in the latest complex techniques.

The endoscope allows us to treat these tumors successfully with lower infection rates, faster recovery and far fewer potential deficits.

Skull-base tumors 

In the past, some skull-base tumors were considered inaccessible or required full craniotomy or invasive oral approaches that carried high morbidity rates. In comparison, endoscopic endonasal surgery provides far better visual and physical access. This is true for most skull-base tumors – especially pituitary adenomas, meningiomas, chordomas, craniopharyngiomas, Rathke cleft cysts and malignancies in the skull base that may have been considered much too risky to treat surgically in the past. 

By accessing the brain via the nasal septum, sphenoid sinus and sella, we can reach skull-base tumors with far lower morbidity than we could via craniotomy. In addition, patients appreciate the quick recovery, lack of externally visible incisions and minimal facial swelling. 

Intraventricular tumors

We also are using neuroendoscopy to precisely access intraventricular tumors via one or two very small cranial burr holes. Endoscopic transventricular techniques can allow access to and removal of lesions inside the ventricles or presenting through the ventricles. This can include colloid cysts, intraventricular tumors and tumors that aren’t completely intraventricular but come close – pineal region or thalamic tumors, for example. The access point for these procedures depends on the tumor location but most often is the top of the head. 

Compared with a traditional craniotomy, this technique, using a much smaller corridor to access the lesion, results in remarkably less damage to existing tissue. Patients heal faster, have lower infection rates and are able to avoid unnecessary damage to neurological function. 

Team approach critical

The success of endoscopic neurosurgery is based on a team approach, with neuro-imaging, surgery and many other disciplines working hand in hand. Specifically for endoscopic endonasal approaches, the role of our ENT colleagues is crucial.

Both surgical techniques gain precision from the same neuro-navigational systems and stereotactic techniques used in open surgery. Image-guidance systems – like a GPS – help us navigate, using skull landmarks and infrared cameras to correlate the patient with the computer model generated by CT or MRI scans. 

These procedures also often require close coordination among the patient’s primary physician, otolaryngologist, endocrinologist, oncologist, neurologist, radiation oncologists and neurosurgeon. 

Future looks positive 

The complexity, utilization and success of endoscopic neurosurgery continue to advance, in part based on improvements and refinements in the instruments, tools and techniques. Interest in the industry is great, and we are seeing continuous changes to make instruments safer and more effective. With steady advancement over the last decade, the techniques for using endoscopy for hard-to-reach lesions are now very well established. As it has in several other areas of surgery, we expect endoscopy to eventually supplant open craniotomy for some procedures and become routine.

To consult with a specialist at the Center for Advanced Brain and Neurological Care, call 913-588-5862 or toll free 877-588-5862. Or visit kumed.com/consult.