360 Minimally Invasive Brain Surgery
In recent years, brain surgery through a variety of different anatomical corridors using smaller, less invasive techniques has become possible. Given the versatility and range of these newer “keyhole” approaches, there has been a shift away from traditional large bony openings (craniotomies). As a result, neurosurgeons now have 360 degree minimally invasive access to a majority of brain, skull base and pituitary tumors as well as other intracranial lesions.
Drs. Kassam and Kelly use the term “360-degree minimally invasive brain surgery” to describe this comprehensive approach with the goals of maximizing tumor removal while minimizing manipulation of critical neural structures. The overarching principle is to create a surgical corridor that avoids crossing the path of nerves and critical blood vessels and minimizes brain manipulation. These precise approaches through a nostril or small scalp incision reduce complications and disfigurement to the patient, while promoting a more rapid, complete and less painful recovery.
This “360-degree” minimally invasive approach to brain surgery has evolved over the last decade because of technological advances in micro-instrumentation, surgical navigation (like GPS for the brain), and the endoscope (surgical telescope) which provides a panoramic view of the intracranial space through smaller openings.
The specific approach used is determined by the anatomy of the individual patient and the exact relationship of the target in question. These approaches include the expanded endonasal route (through a nostril), the supra-orbital route (through an eyebrow incision), the retro-sigmoid route (through an incision behind the ear) and the navigation-guided brain cannula or brain port approach for removal of deeply situated brain tumors.
Despite significant technological advances over the past decade, these minimally invasive approaches are technically demanding, require specialized instrumentation and are certainly not appropriate for all brain tumors. Consequently, there still remains a role for conventional larger craniotomies and skull base approaches, especially when the tumor itself has created a path through the brain and bone, which can be used to optimize the corridor. In some patients, a larger bone opening maybe preferable to moving a nerve or blood vessel to get to a given target. The multidisciplinary team assembled at the BTC-NSI has extensive experience with these conventional approaches totaling over 3000 such procedures over the past 15 years. This large experience allows the team to provide truly comprehensive care using tailored approaches best suited for each patient.
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