Saturday, February 13, 2010

UMBTC ushers in the era of Endoscopic Neurosurgery

Imagine being able to look inside the brain through a straw sized opening or to remove a skull base tumor through the nose. Endoscopic neurosurgery is a way to do just that.

Many surgical specialties use endoscopes to look inside the body. Orthopedic surgeons can peer inside knee, shoulder and elbow joints. Urologists can see inside the bladder, and general surgeons routinely remove gall bladders through the laparoscope.

The advantage of these endoscopic techniques is that they are minimally invasive, and provide an amazingly vivid picture of the anatomy.

The application of endoscopy to Neurosurgery is not new. In fact Neurosurgeons in the early 1900s were using endoscopes designed by Urologists to look inside the fluid spaces within the brain termed ventricles. But it wasn’t until the last few years that equipment advances, imaging tools and a more detailed understanding of microscopic anatomy have made the endoscopic techniques safer.

There are two main areas in which endoscopic techniques excel. The first is the treatment of problems within the ventricles. This might include the removal of cysts or tumors or the treatment of hydrocephalus.

This first video shows highlights of a colloid cyst removal using the endoscope. A colloid cyst is a benign fluid filled cyst. It often grows in the opening that connects the lateral ventricles to the third ventricle (Foramen of Monro). This can cause a backup of fluid and increased pressure termed hydrocephalus. Removing the cyst reopens normal CSF flow pathways.

Most of the patients with hydrocephalus do not have a colloid cyst. For those patients, the treatment is to place a shunt or tube that diverts the fluid from the ventricle to the abdomen. For some of these patients, a hole can be placed in the floor of the third ventricle. This allows the built up CSF in the ventricle to empty into the fluid spaces at the base of the brain where it can be absorbed. This procedure, called endoscopic third ventriculostomy (ETV) can relieve the hydrocephalus without the need for a permanent shunt tube. The second video shows highlights from an ETV procedure.

The other area where endoneurosurgery excels is in the treatment of tumors involving the base of the skull. This includes pituitary tumors and meningiomas. These tumors can be approached through the nose and removed using endoscopic technique. Often the approach is performed with the assistance of ENT surgeons because of their familiarity with sinus anatomy.

Endoscopic neurosurgery offers advantages for both the Neurosurgeon and the patient: for the Neurosurgeon, the anatomy is displayed with rich detail and for patients, recovery is often easier and quicker compared to conventional surgical approaches.

Both intraventricular surgical approaches and anterior skull base surgery can be performed at Marquette General Hospital. Please contact the UMBTC at 906-225-7739 if you have questions regarding these procedures or to schedule a consultation. Please remember that the videos show only brief highlights of the procedures, the actual procedures are longer than the videos.

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