August 1, 2005 For more than a century, neurosurgeons have accessed the brain through the nose, but only recently did they successfully removed tumors with such minimally invasive procedures, leading to patients' quicker recovery. Not all tumors can be treated this way, but surgeons are now able to reach 60 percent of the brain by going through the nose.
PITTSBURGH--Imagine checking into the hospital for brain surgery on a Wednesday and being home to enjoy your weekend with no scars or side effects. High-tech medicine is making that all possible, and the key to its success is as plain as the nose on your face.
Within just two days of her surgery, Lori Cimino was living a normal life with no signs of the tumor that threatened her optic nerve. The key to her quick recovery was the unusual way doctors got into her brain.
Neurosurgeons guided the telescope, called an endoscope, through the nose and directly into Lori's tumor. Then, with tiny surgical instruments attached to the scope, they removed the tumor the same way they went in.
"We go into the center of a tumor and take it out in small little pieces and take these little pieces out through the nose one at a time," otorhinolaryngologist Carl Snyderman of University of Pittsburgh Medical Center, tells DBIS.
For a hundred years, surgeons have been accessing the brain through the nose, but it was just recently that they succeeded in removing a tumor in a minimally invasive way.
Neurosurgeon Amin Kassam, also of the University of Pittsburgh Medical Center, says, "Because we don't have to disarticulate the face and the bones to get there, it allows for these patients to be much more comfortable."
Cimino got rid of her tumor but kept her appearance, something almost impossible had she relied on the old methods of brain surgery. She says, "Pretty much I would be disfigured. They'd cut into my skull. I'd have staples ... My head would be shaved." She is one of 400 successful operations performed by the doctors at the University of Pittsburgh, a success that will allow her to continue to enjoy the beauty around her everyday.
Doctors caution this surgery is not for everyone: some tumors are too hard to reach or are too large to be removed through the nose.
BACKGROUND: The brain has critical tissues at its base and at the top of the spinal cord. Surgery to those areas to remove brain tumors used be very invasive. Now a new approach, called endoscopic transnasal brain surgery (ETBS), allows surgeons to operate safely on large tumors and problematic blood vessels near those important areas. ETBS also offers hope of successful treatment and recovery to those with deep-seated brain tumors that were previously considered inoperable.
HOW IT WORKS: ETBS uses miniature instruments and cameras at the end of long tubes. Surgeons thread these narrow scopes and tools into the soft tissue of the nasal cavity, enabling them to access tumors in previously hard-to-reach areas of the brain.
BENEFITS: The more traditional surgical technique for accessing brain tumors is called a craniotomy. It involved peeling away skin from the face and cutting the skull open. There was a high risk of infection, substantial blood loss and considerable facial scarring from this method, among other complications. ETBS is much less invasive and causes far fewer lingering side effects than traditional skull base surgery. Although the procedure is not without its own risks, patients are usually discharged within several days and incur no scarring from incisions.
WHERE TO FIND IT: The University of Pittsburgh Medical Center will open a 3,000 square foot operating room at its Minimally Invasive Neurosurgical Center, specifically for the ETBS procedure, in July.
WHAT CAUSES BRAIN TUMORS: Brain tumors, like most other cancerous growths, are the result of uncontrolled cell divisions caused by mutations in key genes within those cells -- in this case, the neurons in the brain. Normal neurons don't divide because their genetic coding tells them not to do so. Cancerous neurons are mutated so that the growth switch is turned back on. They begin to divide and multiple uncontrollably, forming a tumor.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.