Removing Malignant Brain Tumors Through The Nose – Revolutionary Procedure Improves Recovery Time

Surgeons at Rush University Medical Center are going through the nose, a technique that has been very successful at removing pituitary tumors, to reach tumors inside the brain. Compared to traditional open surgery, which requires peeling back the skin from the face and cutting large holes in the skull, the minimally invasive transnasal approach offers no scars, a shorter hospital stay, and potentially fewer complications.

While common for pituitary tumors, surgical access through the nose is rare for tumors inside the brain because surgeons must go through the dura mater, the tough membrane that covers the brain and contains the cerebrospinal fluid. Leakage of cerebrospinal fluid can lead to serious complications, such as severe headaches, infection, and meningitis. The confluence of several advanced technologies: miniature surgical instruments, improved endoscopic visualization, computer guided surgical navigation, and a membrane sealant has made it possible to safely access tumors beyond the dura.Guided by a computerized mapping system and an endoscope, a rigid tube that carries a light source and a mini-camera, surgeons drill small holes in a bone at the back of the nose and through the dura. With the camera images magnified on a screen, the surgeon can see exactly where he is threading tiny surgical instruments. The tumor is completely removed through the nostril.To complete the surgery, the hole in the dura must be completely sealed to prevent leaking of cerebrospinal fluid. Surgeons use material made from cadaver skin to create a tough scaffold. Several layers of the material along with fat harvested from the patient are placed over the hole. The material expands to form a tight seal.”This is an exciting surgery. Instead of going from the outside in, we are going from the inside out,” said Dr. Guy Petruzzelli, co-director of the Rush Skull Base Surgery Program. “We have the same ability to remove the tumor, but without scars and with fewer complications.”Dr. Richard Byrne, chairman of neurosurgery at Rush, calls this new approach to removing skull base tumors revolutionary. “With an open surgery, we have to move the brain to gain access to the tumor. With the transnasal approach, it is amazing to see the brain beautifully undisturbed. We remove the tumor with the same borders as open surgery without manipulating the brain.”The transnasal approach is not appropriate for all brain tumors. According to Petruzzelli it can be used for most skull base tumors, or tumors at the junction of the cranial skeleton and the nose or spine. The procedures require close cooperation between an experienced neurosurgeon and head and neck surgeon.”Both surgeons must work as an integrated unit, moving away from the idea of ‘my part’ or ‘your part’ of the operation. The entire procedure becomes a combined effort focused on the patient and their recovery,” said Petruzzelli. “Minimally invasive skull base surgery should only be attempted at medical centers with high levels of expertise in neurosurgery, head and neck surgery, radiology and anesthesia.”(Source: Rush University Medical Centre : June 2007.)