Oct. 26, 1998 LOS ANGELES (October 23, 1998) - A fully endoscopic procedure now available at Cedars-Sinai Medical Center's Skull Base Institute is resulting in minimally invasive, highly successful brain 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 -- 4mm 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 approximately 12 Skull Base Institute patients who have undergone this type of delicate brain surgery in the past three months, virtually all have gone home within 48 hours of surgery 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.
Amelia Anderson, 41, a vice present at City National Bank in Beverly Hills, also enjoyed a rapid recovery. "I had the surgery on Monday, went home on Wednesday, and by Saturday I had begun daily walks down the block. Within a couple of weeks, I was driving," she says.
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 -- to slip in and out without its knowing we were there, so to speak."
"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:
o No scarring ("I really like the fact that no one can look at me now and even know I had surgery," says Anderson.)
o No nasal packing.
o 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).
o 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.)
o Less discomfort as the brain itself is not disturbedo Faster overall recovery, return to work and normal activities.
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