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Endoscopic Acoustic Neuroma Surgery
An acoustic neuroma is a benign tumor of the eighth cranial nerve - the vestibulocochlear nerve that travels from the brain to the ear. It usually manifests itself with one-sided hearing loss. But other cranial nerves, particularly one affecting the face, are in close proximity. Therefore, while the tumors themselves are considered benign because they remain intact and do not metastasize to other organs, they can cause serious complications and eventually death as they grow, exerting pressure on nerves and on the brain itself.
To remove these tumors, surgeons have traditionally relied on one of two common approaches. The most frequently used procedure involves several surgeons who drill through the mastoid bone behind the ear to access the tumor. For smaller tumors, the "retrosigmoid" or "sub-occipital" approach offers the possibility of saving some hearing. Instead of going through the mastoid bone, surgeons make a large incision behind the bone, open the skull, push the brain aside, and take the tumor out from the back.
At the Skull Base Institute, our surgeons have developed a fully endoscopic approach. Instead of drilling through the mastoid bone or cutting a large opening in the skull, our surgeons make a burr hole the size of a dime behind the mastoid. From this point, thin and precise endoscopic instruments are inserted - slipping them between the brain and skull to the site of the tumor.
The entire procedure is performed using minimally invasive techniques and allows patients to be discharged within 48 hours.
Endoscopic Craniopharyngioma Surgery
A craniopharyngioma is a benign tumor that develops near the pituitary gland. Craniopharyngiomas cause symptoms in three different ways: 1) by increasing the pressure on the brain (intracranial pressure) 2) by disrupting the function of the pituitary gland, and 3) by damaging the optic pathways. Increased pressure on the brain causes headache, nausea, vomiting (especially in the morning), and difficulty with balance.
Traditionally, open surgery has been the main treatment for craniopharyngiomas. However, at the Skull Base Institute, three different minimally invasive endoscopic procedures allow us to tailor the procedure depending on the size and location of the tumor. These include an endoscopic transnasal approach similar to that offered for pituitary tumors, and a minimally invasive endoscopic approach that involves placing an incision within the skin crease in the bridge of the nose and performing a one centimeter key hole midline frontal craniotomy. This latter procedure is ideal for most craniopharyngiomas and patients are discharged within 24 to 48 hours.
Craniopharyngiomas that extend laterally are approached through the most recent technical innovation at the Skull Base Institute. This fully endoscopic approach involves placing an incision within the hair of the eyebrow, performing a 1-1.5 cm keyhole supraorbital opening and advancing the endoscope along the floor of the anterior cranial fossa underneath the frontal lobe. This approach allows a panoramic visualization of the ipsilateral anterior fossa and a partial visualization of the contralateral anterior fossa.
Although most craniopharyngiomas are completely resected through one of these minimally invasive approaches, occasionally giant lesions may require a combination of the endoscopic transnasal approach with either the endoscopic frontal approach or the endoscopic supraorbital approach. This can either be done simultaneously or can be staged as two separate procedures. This allows a complete and total resection of virtually most craniopharyngiomas through minimally invasive techniques.
Minimally Invasive, Tailored Meningioma Surgery
Meningiomas are tumors that originate from the meninges, which are membrane-like structures that surround the brain and spinal cord. Typically they are benign and occur as solitary masses, but instances of malignancy and multiple concurrent lesions have been reported. About 15 to 20% of all primary brain tumors are meningiomas, and commonly occur in patients in their 40s through 60s, affecting predominantly women.
Since the meninges surround the entirety of the brain and spinal cord, meningiomas can occur anywhere in the central nervous system. Signs and symptoms depend on the size and location of the tumor. Symptoms usually develop as a result of compression of surrounding neurovascular structures.
Intercranial meningiomas may manifest as headache, stroke, seizure, loss of vision, or personality change. Meningiomas of the spinal cord may present with pain or weakness at the level of cord involvement. Due to their slow growth characteristics development and progress of symptoms can be subtle and extend over a period of years.
Treatment options are varied ranging from conservative expectant therapy to aggressive surgical resection. The goal of surgery is complete tumor removal. The technique employed depends on the location of the tumor. When the tumor cannot be completely resected at the time of surgery, adjuvant radiotherapy or radiosurgery may play a role in subsequent management of the patient.
Tumors once thought to be "unresectable" are now regularly and safely removed at the Skull Base Institute. Meningiomas located at the base of the skull are very difficult to access. Our use of highly specialized surgical techniques, sophisticated intraoperative monitoring equipment, and minimally invasive surgical instruments allow us to expose hard-to-reach areas in their entirety without disturbing surrounding critical neurovascular structures.
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