Brain Surgery Continues to Evolve

Being diagnosed with a brain tumor can be devastating news. But thanks to a decade of advances in minimally invasive surgical procedures and improvements in instrumentation, patients today have a far better chance of recovery—without the risks of traditional “open-skull” surgery or other techniques.

A study published in the October 2008 issue of Operative Neurosurgery, evaluated operations performed by a single surgeon over 10 years and found that when a surgeon is equipped with sophisticated instruments and extensive experience, minimally invasive procedures can be used to remove certain brain tumors through the nose, both safely and effectively. The study focused on 812 patients, most with pituitary adenomas (a non-cancerous yet dangerous tumor of the brain), all of whom were operated on by Daniel F. Kelly, M.D., Director of the Brain Tumor Center at Saint John’s Health Center.

Dr. Kelly is a specialist in endonasal transsphenoidal surgery, a minimally invasive procedure that allows doctors to use a natural opening—a nostril—to access the pituitary gland and surrounding area. Earlier surgical strategies included cutting through the skull (craniotomy), or making an incision under the upper lip. This latter procedure, called sublabial transsphenoidal surgery, has major drawbacks including pain caused by the incision and lip retraction; in addition, numbness of the upper lip is a frequent side effect. Also, the nasal cavity must be packed with gauze for several days after surgery, adding to the patient’s discomfort.

“As our previous studies have shown, most patients prefer the idea of a minimally invasive procedure that can be carried out through a natural opening rather than an incision,” Dr. Kelly says.