Endoscopic Surgery for Brain Tumors

A unique collaboration to help patients with brain tumors is underway at The George Washington University Hospital where otolaryngologists (physicians who treat the ear, nose and throat) and neurosurgeons join forces to perform minimally invasive surgeries of the skull base where the specialties converge.

Traditionally, anterior skull base and brain tumors were removed through the bony skull, which required large skull and facial incisions, bone flaps, and brain retraction to reach these tumors and remove them through a maze of blood vessels and nerves.

GW Hospital is now offering a minimally invasive alternative where a team of surgeons remove these tumors endoscopically through the patient's nose, a natural opening, thus avoiding the facial or skull incisions associated with major surgery. First, an otolaryngologist creates a surgical pathway to the skull base using an endoscope, a thin, lighted tube with a small video camera on the end. Then, in partnership with a neurosurgeon, the otolaryngologist performs the delicate procedure to carefully extract the tumor and remove it through the nose.

The endoscope allows the surgeons to remove the tumor, yet preserve normal structures. The surgeons then reconstruct the skull base to provide complete closure of the skull base and seal off the opening between the brain and the nose. Most patients have fewer complications, have no visible scars and recover much faster.

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:

• Pituitary tumors
• 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