Supraorbital Eyebrow Surgery
The supraorbital approach through the eyebrow is effective for many patients with meningiomas, craniopharyngiomas and other tumors that located near the optic nerves and pituitary gland, as well as gliomas and metastatic brain tumors that are positioned in the frontal and temporal lobes.
This versatile, minimally invasive approach minimizes normal tissue disruption and brain retraction, allowing for a more direct approach to treating these lesions. Occasionally, an abdominal fat graft may be necessary to seal large nasal sinus defects.
This approach is typically performed with the assistance of an endoscope, allowing for detailed visualization of the area that will be treated. Patients recover well after the surgery and are satisfied with the cosmetic results as well.
Tumors of the frontal or middle fossa are today normally treated usind this surgical approach instead of the traditional pterional (fronto-temporal) or bi-frontal craniotomies that involve larger scalp incisions and bony openings. Endoscopy and minimally invasice surgical instruments allow excellent access to treating tumors through very small openings.
Endoscopic Endonasal Method
Endoscopic endonasal surgery is a state-of-the-art procedure that involves accessing the pituitary gland and surrounding structures through the nasal canals, eliminating the need for traditional open surgery. This technique utilizes a high-definition endoscope, a thin and flexible tube with a light and camera, which allows surgeons to visualize and access the surgical area with precision. The endonasal approach uses the nostrils as natural surgical corridors to remove pituitary adenomas, and many skull base brain tumors.
The endonasal route is the preferred surgical approach for almost all pituitary adenomas and Rathke’s cleft cysts, as well as most craniopharyngiomas, clival chordomas and many midline menigiomas. Utilizing high-definition endoscopy (surgical telescope), surgical navigation (“GPS for the brain”) and Doppler ultrasound for carotid artery localization, the endonasal approach has evolved into a safe and effective procedure in experienced hands. Major advantages of the endonasal route are: avoidance of brain retraction, minimal or no manipulation of the optic nerves, no facial incisions and rarely any need for nasal packing.
Our surgeons have one of the world’s largest experiences in endoscopic endonasal skull base surgery for all types of pituitary adenomas and midline brain tumors.
Retromastoid Craniotomy
The retromastoid approach (also known as the retrosigmoid approach) uses a small surgical opening behind the ear to reach and remove acoustic and trigeminal schwannomas, meningiomas, epidermoid tumors, and tumors of the cerebellum such as hemangioblastomas and metastatic brain tumors.
It is also the main approach for microvascular decompression of the cranial nerves (for trigeminal neuralgia or hemifacial spasm). This operation has been augmented with the introduction of the endoscope, allowing for visualization around corners, limiting the need for extensive tissue removal or brain retraction.
Occasionally, an abdominal fat graft is necessary to seal the opening and prevent a cerebrospinal fluid (CSF) leak.
Overall, this operation is associated with great access to the surgical area with minimal cosmetic or soft-tissue damage and relatively quick patient recovery.
Gravity-Assisted Methods
The gravity-assisted Trans-Falcine approach is ideal for the resection of meningiomas, gliomas (astrocytomas, ependymomas, oligodendrogliomas, intraventricular tumors) and metastatic brain tumors.
By using gravity surgeons allow for the brain to change its position, removing the need for brain retraction and allowing the surgical instruments to reach and treat deep lesions in the brain. The angled endoscopes allow for excellent visualization and safe tumor resection.
Compared to traditional approaches, patients have a relatively quicker recovery and increased preservation of neurological function.
The Trans-Tentorial approach is ideal for patients with certain pineal tumors and cysts, gliomas, metastatic tumors and cerebral cavernous malformations of the inferior-medial posterior temporal and occipital lobes.
This surgical approach takes advantage of the structures separating the cerebral cortex from the other structures of the hindbrain and brainstem, minimizing the need for brain retraction.
The operation is performed in a sitting position to achieve this relaxation of the brain. Patients have to undergone a pre-operative cardiac evaluation to ensure safe surgical outcomes. This procedure is performed endoscopically, allowing for improved visualization and a smaller craniotomy.
Compared with other approaches, it has less risk to the occipital lobes (vision processing region) and decreased resection of tissues.
Brain Port Method
Brain path procedure, or Brainport approach can be performed to remove gliomas, metastatic brain tumors, cerebral cavernous malformations and blood clots deep within the brain, that were previously considered inoperable, while minimizing the risk of damaging the surrounding dense and delicate neural structures that control brain and body functions.
Using the fiberoptic tractography and BrainPath®, our neurosurgeons can more safely remove many tumors that were tumors and blood clots, delivering the best outcomes for patients.
Using imaging and navigation systems, the BrainPath® device is inserted into the brain through a small opening. Its cone-shaped sheath slips through the dense and sensitive white matter tracts of neural networks to the location of the tumor or clot.
With the aid of high-powered optical tools, the NICO Myriad®, is inserted through the sheath. The device, which is about the diameter of a pencil, is used to remove the tumor or clot. This approach may result in less blood loss and faster recovery for patients.
The Myriad® device also has a filter to capture the targeted tissue in a sterile and intact form to be used for pathological analysis and if needed, for genomic tumor sequencing.