Endoscopic brain surgery is a procedure used primarily to treat brain tumors. It is considered a minimally invasive brain surgery that allows neurosurgeons to identify and treat conditions that are deep within the brain.
“This type of surgery allows us to treat brain tumors less invasively than traditional open brain surgery, while still affording us the ability to get an in-depth view of the brain.
During this procedure, thin tubing that transmits video images of the brain is inserted through one or two small incisions in the skull or through an opening in the body. This tube-like instrument, called an endoscope, contains a small camera that allows the neurosurgeon to see detailed images of the problem area in the brain.
“Endoscopic approaches have truly transformed how we treat tumors, particularly because endoscopic techniques give us such a clear visualization of the tumor” .This approach also does not always require us to access the brain through the skull. We’re able to access the brain through pathways like the nose and sinuses as well.”
The neurosurgeon will use the images transmitted by the endoscope as a guide for removing the tumor or repair the affected area of the patient’s brain. The removal of the tumor or damaged area is performed with specialized surgical instruments. In minimally invasive endoscopic brain surgery we intend to reach pathology like a tumor through natural openings, like a nostril or small incisions with minimal or no brain retraction. An endoscope is inserted into this opening and used to visualize and perform the neurosurgical operation. The surgery is performed while looking at a monitor which displays magnified real-time video from the endoscope. The rest of the surgery is done with the similar techniques as to open surgery, but requires the use of special instruments and allows for less retraction and chance of injury to the brain. The same principles are used for operations of the spine.
This new, endoscopic surgical technique is most commonly used in patients with benign lesions such as pituitary adenomas. However, surgeons are starting to use it to remove other selected brain tumors as well. Some of the types of lesions that may be treated with this new approach include:
Meningiomas (tumors arising from the lining of the brain)
Craniopharyngiomas (a type of tumor derived from pituitary gland tissue)
Rathke's cleft cysts (benign cystic lesions that affect mainly the pituitary gland)
Chordomas (rare, slow-growing malignant tumors at the base of the skull)
Spinal fluid leaks/rhinorrhea
The goal of surgery depends on what the procedure is for. This may be to remove a tumor, biopsy a mass, decompress a cranial nerve, remove a herniated disc, or treat any number of neurosurgical problems.
You will have an office visit with a neurosurgeon, ENT surgeon, and endocrinologist before surgery. A consult with an ophthalmologist may be necessary if you have vision problems. During the office visit, the surgeon will explain the procedure, its risks and benefits, and answer any questions. Next, you will sign consent forms and complete paperwork to inform the surgeon about your medical history (i.e., allergies, medicines, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery. You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray, and CT scan) several days before surgery.
Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve) and blood thinners (coumadin, Plavix, aspirin) 1 week before surgery. Additionally, stop smoking and chewing tobacco 1 week before and 2 weeks after surgery as these activities can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.
After surgery you will be taken to the recovery room, where vital signs are monitored as you awake from anesthesia. Then you'll be transferred to a regular room or the intensive care unit (ICU) for observation and monitoring. You will be encouraged to get out of bed as soon as you are able (sitting in a chair, walking).
After surgery you may experience nasal congestion, nausea, and headache. Medication can control these symptoms. An MRI of the brain will be obtained the day after surgery. In 1 to 2 days, you'll be released from the hospital and given discharge instructions.
4 to 8 weeks
You will probably feel very tired for several weeks after surgery. You may also have headaches or problems concentrating. It can take 4 to 8 weeks to recover from surgery. Your cuts (incisions) may be sore for about 5 days after surgery.
With any surgery, there are risks involved. Rebound surgeons educate their patients on the best treatment options for their particular condition and communicate the potential risks.