Endoscopic skull base surgery Endoscopic skull base surgery is a minimally invasive technique of brain surgery,that enables surgeon access to inaccessible areas of the brain where certain types of tumors and abnormalities may develop. The skull is made of many bones and cartilages, the base of skull is formed by bones of the eye socket, roof of the nasal cavity, some sinuses and the bones that surround the inner ear. The skull base is a complicated area with different blood vessels, openings of the spinal cord and nerves. It allows for the removal of cancerous and non cancerous tumors and abnormalities underside the brain, and the top of the spinal column as these areas are difficult to see and reach, without the need for a large incision in the skull; instead, tumors are removed through the mouth, nose, or a small opening above the eyebrow.
Traditionally the tumors in the base of the skull were removed through the bony skull, which required large skull and facial incisions, bone flaps, and brain retraction to reach these tumors and remove them through a network of blood vessels and nerves. Endoscopic skull base surgery is one of the latest, safe, and fast techniques that use highly specialized instruments and a high definition endoscopic camera system. What is Endoscopic skull base surgery? Endoscopy is a technique of using a thin rigid tube with a lens and a light source to look into a body cavity through a tiny opening. An endoscope is like a small camera that looks at the pathology or problem. The endoscope includes a light source and is connected to a monitor. The surgery is performed while watching the screen and the actual target size is magnified over 100 times.
The aim is to get to the target pathology or problem while minimizing the trauma to the surrounding tissues. This approach is often used to treat both brain and spine disease in neurosurgery. The endoscopic skull base surgery is performed using an endoscope, which is a small, rigid tube with a camera and a small set of surgical instruments attached. This procedure is often used to remove a tissue sample for further testing (a biopsy) or to remove part or all of a brain tumor. This approach allows the surgeon to reach these areas without the necessity for large incisions or removal of parts of the skull making recovery quicker and less painful. Indications for Endoscopic skull base surgery
• Tumours of the base of the Skull
• Pituitary tumors
• Meningiomas
• Craniopharyngiomas (a kind of tumor-derived from pituitary gland tissue)
• Chordomas (rare, slow-growing malignant tumors at the bottom of the skull)
• Spinal fluid leaks/rhinorrhea etc.
Procedure of Endoscopic skull base surgery: The brain tumor or any other pathologies in the base of the skull is surgically removed through natural openings like a nostril or small incisions with minimal or no brain retraction. The procedure starts with the insertion of an endoscope through the nose and used to visualize and perform the neurosurgical operation.
This prevents the need for incision in the skull part to access the brain and also gives a far better highly illuminated magnified view of the base of the skull. The surgery is performed while viewing a monitor that displays magnified real-time video from the endoscope.
The surgery is completed with similar techniques as open surgery, but requires the utilization of special instruments and allows for less retraction and chance of injury to the brain and therefore called a minimally invasive endoscopic skull base surgery. The tumor is removed with clear margins. After the removal, the reconstruction is done using vascular pedicle grafts with or without bone graft. The tissue grafts accumulated from other parts of the body may be used for reconstruction.
To hold the tissues in place tissue glue is used. What are the risks of endoscopic skull base surgery? Any major surgery carries some risk, most people get through this surgery and heal well without problems, but complications can develop. The risks are mostly the same as for open surgery and are specific to the area of the brain or spine being operated on and the nature of the disease or pathology. However, as less retraction is required most of the risks are decreased compared to open surgery. Possible risks include:
• Reactions to the anesthesia
• Excessive bleeding
• Hematoma (a pooling of blood in the wound site)
• There can be damage to veins, arteries, nerves, and other structures in the area
• Cerebrospinal fluid leaking from the nose
• Infection
• Slow healing
• Blood clots
• Pneumonia The procedure may carry other risks, depending on one’s specific medical condition.
Advantages of Endoscopic skull base surgery
• No incision is made on the skull or any other part of the body
• Leaves no scar
• Surgery is initiated through a natural opening like the mouth or nostril
• Avoids pressure on the brain
• Both benign and malignant tumors can be treated
• Facilitates the very best rate of resection with minimal morbidity
• Minimal stay in the hospital (2-4 days after surgery) Because of the surgical precision provided by the endoscope the success rate is incredibly high.
Endoscopic skull base surgery offers a variety of benefits over open brain surgery; as with other minimally invasive procedures, it is often associated with shorter recovery times and lower complication rates. Dr Venugopal S is a leading Neurosurgeon in Bangalore with experience of more than a decade post qualification. Dr.Venugopal is having hands-on experience in various subspecialties of Neurosurgery which includes complex Brain and Spine diseases in both adult and paediatrics. For more information about endoscopic skull base surgery or any of the other advanced brain tumor treatments, or problems related to the spine contact Dr Venugopal S. Or Visit us: www.neurosurgerybangalore.com
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