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New minimally invasive, fully endoscopic prodedure may result in same-day skull base surgery for pituitary tumors
LOS ANGELES (April 22, 1999) -- A fully endoscopic procedure now available at Cedars-Sinai Medical Center's Skull Base Institute is resulting in minimally invasive, highly successful surgery for patients with pituitary tumors and other skull base disorders. According to Hrayr Shahinian, M.D., director of the Skull Base Institute, the new procedure utilizes a tiny endoscope -- 2.8mm wide and 20cm long -- with angled tips to provide a panoramic view of the brain. Because the point of entry is through a nostril, there is no scarring, the brain is undisturbed and both the time required for the actual surgical procedure, as well as the overall recovery time are dramatically reduced.
Of the more than 50 Skull Base Institute patients who have undergone this type of delicate brain surgery in the past year, virtually all have gone home within 48 hours of surgery - the most recent 12 patients have gone home within 24 hours -- and all have enjoyed rapid overall recovery. "I stayed in the hospital for a couple of days, then went roller-blading nine days after I went home," says Ken Baker, 28, a staff correspondent for People magazine. Baker underwent the procedure on July 8, 1998, to remove a large (2.5cm) hormone-secreting prolactinoma.
Brad Sauer, 47, had previously undergone four surgeries to remove his pituitary tumor, and compares his previous surgical experiences (all of which were done using the conventional "open" approach) to the fully endoscopic approach taken by Dr. Shahinian last month. "After the first three operations, I had severe spinal headaches which were not alleviated by medication," he says. In addition, he says the nasal packing used in those procedures was very uncomfortable and he had numerous complications. The fourth operation was better, he says, "but within three months I was having headaches again." An MRI showed that the tumor was back and growing fast.
In contrast, says Sauer, the fully endoscopic approach taken by Dr. Shahinian was much less invasive. "There was no need for a spinal tap, nor for a Lumbar drain," he says. "There was no nasal packing, I had no post-operative headaches this time, and needed very little pain medication. As for the surgery itself, they used a short-acting anesthesia, so I was fully functioning again very quickly - which had not been the case with my previous operations." Perhaps most significant of all, was the fact that thanks to the panoramic view provided by the endoscope, Sauer's tumor was removed in its entirety.
According to Dr. Shahinian, the new endoscopic technology provides surgeons with an unprecedented panoramic view of the tumor site, allowing them to look around corners and make a full visual assessment. "This enhanced visibility helps us know exactly how to best approach the tumor without disturbing the brain, itself," he says. "In any type of brain surgery, our goal is to disturb it (the brain) as little as possible."
"The second thing the panoramic view provides is the ability to nearly always remove the tumor in its entirety. Prior to the availability of the panoramic view endoscopes, we could not always see or remove the whole tumor, as often a portion of it 'hides' around a corner. Now that we can see it fully, we can remove it fully."
Baker's tumor was a classic example, says Dr. Shahinian. "In his case, a portion of the tumor extended around a corner into the right cavernous sinus -- a very dangerous area. This represents a venous pool of blood that houses the internal carotid artery, one of the main sources of blood to the brain, as well as nerves that go to the eyes. Without the endoscope, it would have been impossible to see around the corner into this area, and it would have been too risky to try to enter the area blind. The upshot would have been that some of the tumor would have remained, and it would have eventually grown back, requiring additional surgery."
The advantages to the patient are numerous:
- No scarring ("I really like the fact that no one can look at me now and even know I had surgery," says Amelia Anderson, 41, a bank vice president and a patient of Dr. Shahinian's.)
- No nasal packing
- Shortened surgery time (At present about 2 hours compared to 4 hours for traditional pituitary surgery. Dr. Shahinian expects that time to shorten even more)
- Dramatically reduced length of stay in the hospital (At present, about 2 days compared to 5 days for traditional pituitary surgery. Dr. Shahinian anticipates that within the next two years, this may become a "same-day" surgery.)
- Less discomfort as the brain itself is not disturbed
- Faster overall recovery, return to work and normal activities
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