Endoscopic Skull Base Surgery

The base of the skull is a fairly crowded and complicated area. It’s also an area that may need to be accessed to remove an abnormal growth. In some instances, minimally invasive endoscopic skull base surgery may be performed to remove a tumor via the nose and sinus passages.

• Surgery of this nature is performed using special techniques and instruments
• Prior to the development and increased availability of endoscopic surgery, the only option for patients was traditional surgery performed through large skull incisions

Endoscopic skull bases surgery is performed with an endoscope. This special type of instrument is a tube-like device with a light and camera attached to it. When used for skull base surgery, it’s inserted through the nose. The base of the skull is accessed via the sinus cavities. If the growth is located behind other structure in the brain, a special angled endoscope may be used to avoid injury while still allowing access to the tumor cavity.

An MRI may be performed after the surgery is completed to confirm that all of the tumor was removed. Computer-assisted navigation is typically used during procedures to allow the surgeon to have a detailed, in-depth view of the affected area of the brain. Imaging is sometimes used while endoscopic surgery is being performed when constant detailed visualization is needed for problematic growths to ensure that the growth is safely reached and eliminated.

One of the most appealing advantages of endoscopic skill base surgery is the ability to treat growths that would otherwise not be able to be safely removed. Smaller instruments offer greater flexibility and allow surgeons to have better dexterity with what areas are accessed. Patients also typically benefit from:

• Little or no issues with visible scarring
• Fewer risks while the surgery is performed
• Shorter hospital stays
• Minimal discomfort while surgery is performed
• No use of radiation during the course of surgery

Endoscopic skull base surgery can be done on patients with either benign and cancerous growths and other abnormalities at the base of the skull or around the first few vertebrae of the spinal column. A variety of growths may be treated with endoscopic techniques, including cysts that developed at birth, pituitary tumors, and growths caused by infections. This type of surgery has been successfully performed on children and adults with an assortment of growths, including those affecting mucus-secreting glands.

In addition to treating brain tumors and secondary malignant growths that spread from the original location, endoscopic skull base surgery may be performed to address other issues affecting this area, including abnormalities such as cerebrospinal fluid fistulas (abnormal pathways), fluid-filled rathke cleft cysts (RCCs), and issues with acromegaly and other hormonal disorders.

Endoscopic skull base surgery may also be performed on patients with Cushing’s disease, a rare condition where too much of the hormone cortisol is produced. Patients with diabetes sometimes have issues with invasive fungal sinusitis affecting nasal passages. Other skull base conditions often considered treatable with endoscopic procedures include:

• Optic nerve compression
• Squamous cell carcinoma
• Chondroma
• Epidermoid and dermoid cysts
• Abnormally connected arteries (arteriovenous malformations)
• Bulging areas in blood vessels in the brain (cerebral aneurysms)

One of the most promising of the possibilities with endoscopic skull base surgery is the ability to treat some complex tumors. “Complex tumors” are defined as growths that would normally be considered inoperable because of location or difficult to effectively treat surgically without serious risk for the patient. Such tumors may include oddly shaped or located tumors.

Determining if a patient is a good candidate for an endoscopic procedure typically starts with a comprehensive assessment of the tumor or abnormality located in or around the base of the skull. This determination often involves image studies and a review of a patient’s overall health and related symptoms that are being experienced.

Recovery from endoscopic skull base surgery will vary based on the size of the growth, where it was located, and a patient’s overall health. However, minimally invasive surgery often involves a shorter recovery time and fewer risks since incisions are smaller and the skull won’t have to be opened, although traditional surgery may still be necessary under certain circumstances. Ideal candidates for most endoscopic procedures are individuals who are otherwise healthy without underlying conditions that may present complications.

Dr. Djalilian is one of the earliest surgeons to adopt endoscopic surgery as an adjunct to traditional skull base surgery to remove tumors in the posterior skull base. These techniques have been refined to use in other lesions of the skull base such as petrous apex tumors, cysts, and cholesterol granulomas, meningiomas, petrosal approaches, among others. In addition, we routinely use endoscopic procedure as an adjunct for acoustic neuroma surgery in the retrosigmoid and middle cranial fossa approaches.