The Skull Base Institute in Los Angeles, which has been performing an alternative minimally invasive endoscopic procedure to remove such tumors for 20 years, has released a study whose results are astounding. Out of the 1,815 patients who have undergone the procedure, there have been no incidents of stroke, blindness, injury to the carotid artery or death. Also recorded is a less than 6% recurrence rate. The procedure involves no incision or sawing into any bone, but uses an endoscope (a small instrument attached to a tiny video camera) that reaches the tumor via the nasal cavity. The tumor is removed piece by piece without damaging the pituitary gland itself and the procedure takes approximately 1.5 hours to perform, instead of 3-6 hours like the invasive surgeries do.
According to Skull Base Institute Medical Director and founder Hrayr Shahinian, M.D., who has performed more than 6,000 endoscopic brain surgeries during his career, only now is the medical community recognizing the great benefits of endoscopy over traditional surgery, yet 98% of all brain surgeries still utilize the traditional invasive methods.
“I’m delighted that other surgeons are beginning to look at less invasive techniques when, as our study suggests, the benefits are too great to ignore. Patient safety and recuperation have to be priority number one,” he said. “Also, as is the case with the more invasive approaches, patients are being unnecessarily harmed since surgeons encounter higher rates of complications.”
The most common approach to removing pituitary tumors by neurosurgeons is the transsphenoidal, which involves going through a wedge-like bone situated behind the nasal passages and below the brain. (The back wall of the sinus covers the pituitary gland.) For this approach, surgeons make an incision along the nasal septum or under the upper lip. Then to reach the pituitary, the boney walls of the sphenoid sinus are opened with surgical chisels, drills or other instruments depending on the thickness of the bone and sinus. Metal retractors or speculums are always required.
The even more invasive craniotomy has the surgeon operating through an opening in the front or side of the skull. The surgeon has to carefully work beneath and between the lobes of the brain to reach the tumor. The craniotomy has an even higher chance of brain injury than transsphenoidal surgery.
Shahinian has conducted extensive research on minimally invasive brain surgery and published dozens of peer-review scientific studies on it. In addition to writing the definitive textbook on the subject, Endoscopic Skull Base Surgery, he is working with NASA on finalizing the next wave of surgical instruments that are high-def and 3D.