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Endoscopic Surgery

  • Endoscopic Endonasal Skull Base Surgery
  • Endoscopic Endonasal Pituitary Adenoma

We routinely use a purely endoscopic technique to remove pituitary tumors. The endoscope has revolutionized the surgical treatment of pituitary tumors. The ability to directly see and remove a tumor in an otherwise difficult to reach area, as the cavernous sinus, allows a more complete resection of the tumoral tissue and also to distinguish better the normal pituitary gland to be preserved, which decreases the postoperative hormonal deficits and increases the total resection of tumors.

The endoscopic technique provides a wide-angle vision field and a greater detail than microsurgical techniques. The superb visualization opens a new world for endonasal surgery making that an expanded endonasal approach (EEA), which represents the procedure of choice to resect intracranial tumors previously operated through a craniotomy, resulting in an increase in patient comfort and safety, early hospital discharge and, more importantly, a more complete resection with easier identification and preservation of normal brain structures.

By operating through the natural pathway of the nose and nasal sinuses, this surgery can be performed without a visible scar on the face or scalp. There are typically fewer, if any, lingering side effects compared to traditional craniofacial surgery. Patients can often be discharged the day after surgery or in a few days in more complicated procedures.

The Endoscopic Pituitary Adenoma/Skull Base Surgery program, currently led by Dr. B. Oliver and Dr. H. Massegur, has refined numerous surgical techniques for complex lesions of the skull base treated transnasally using the endoscope as the sole visualization tool. This “inside-out” approach reduces the morbidity associated with traditional open skull base approaches.

Our center combines the expertise of neurosurgeons, otolaryngologists, plastic surgeons, radiation oncologists, and interventional radiologists to facilitate interdisciplinary treatment of complex tumors and vascular lesions at the base of the brain.

The base of the skull has proven to be one of the most challenging anatomic regions to access. In the late 1980s and early 1990s significant breakthroughs were made, but those approaches involved facial disarticulations and removal of the bones and facial skeletons. In the latter part of the 1990s decade it became apparent that the morbidity related to gaining access to this space was very significant.

 

The incorporation of endoscopy into neurosurgery was adopted and changed the way skull base surgery is performed nowadays.

 

In 2005 the skull base program at Neuroinstitute Oliver-Ayats made a formal commitment to take advantage of this technology to access the skull base, and then progressively for other brain areas. Much work had been done before in the ENT field in using the nose to access the region, but had stopped short of the skull base. We now extend this to approach and resect tumors of the skull base and then access the brain itself. In fact there is no need for incisions at all because the nose provides the passage.

Specifically, using this approach we have been able to progressively access the entire skull base. So far (until May 2012), we have undertaken 312 operations, and have been able to extend this technique to reach central brain tumors and remove them completely through the nostril.

In essence the procedure allows both the approach and resection of the tumor to be done with minimal disturbance to the surrounding tissues.

Our Pituitary Adenoma and minimally invasive Skull Base Center has an accumulated experience in the treatment of around 1,000 pituitary adenomas and some 500 skull base tumors.