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Image-guided Endoscopic Expanded Endonasal Approach for Skull Based Tumors

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Tumors of the skull base have traditionally been among the hardest to treat surgically, owing to their proximity to key blood vessels, nerves and critical brain structures. Open base-skull surgeries often take hours to perform, and involve removing a section of the skull to gain access to the brain. However, the surgeons at Florida Hospital’s Brain and Spine Cancer Program have access to the latest in cutting-edge technology, the image-guided endoscopic expanded endonasal approach for skull base tumors. In essence it is a minimally invasive procedure that allows surgeons to hone in on the tumors and remove them without having to make incisions, let alone cut a hole in the skull. If you have been diagnosed with skull-base tumors, contact us to determine if this procedure is right for you.

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In recent years, doctors have been working with new technology in an effort to make once-difficult surgeries, such as surgeries to remove tumors of the base of the skull, easier and safer. While the endoscope had for many years been used in gynecologic and laparoscopic procedures, it is only more recently that this lighted, thin, rigid tube was employed to help surgeons visualize and remove tumors from the base of the skull, using one of the patient’s nostrils as an entry point for the endoscope, and the other for the surgical tools, a procedure called an endoscopic expanded endonasal approach. This approach offers surgeons a more targeted view of the tumor and at least somewhat obviates the need to manipulate or move critical brain structures to access the tumor. In essence, thanks to this approach, doctors can now access and resect tumors at the base of the skull in a minimally invasive way, without needing to make incisions or disassemble the face to access the tumors, and with offering patients a better prognosis during and quicker recovery after surgery.

The image-guided endoscopic expanded endonasal approach for skull base tumors offers an even greater level of precision. By incorporating three-dimensional image-guided computer navigation systems, surgeons can now create a sort of GPS for the brain, enabling them to safely and confidently navigate around the critical structures of the brain to locate and treat tumors at the base of the skull. Image guidance uses the data acquired during preoperative CT scans and downloaded into a computer workstation to develop a three-dimensional view of the surgical area. Before surgery, the patient is fitted with a headset equipped with either an infrared or electromagnetic signaling device. This device enables the coordinates of the surgical instrument being used to be displayed on a computer monitor alongside real-time video obtained from the endoscope.

Whereas open surgery to reach the base of the skull (and then reconstruction of the skull afterward) takes many hours, a team of specialists meticulously navigating around blood vessels, nerves and tissue, and the prospect of potentially lengthy rehabilitation, the image-guided endoscopic expanded endonasal approach for skull base tumors offers patients a safer, more precise surgery, a quicker recovery and fewer risks of complications.