Endonasal Brain Surgery



Sarah Tillman wants to eventually get pregnant, but couldn’t because of a benign brain tumor in her pituitary gland.  “It was a tumor a benign tumor its not a cancer but it’s a tumor that if you have an elevated prolactin and its producing prolactin which can prevent her from becoming pregnant,” says her neurosurgeon, Dr. Ted Schwartz of Weill-Cornell Medical Center.


The tumor is in a tricky spot:  in the front of the skull base.  This is where you’ll find the optic or eye nerves that give us sight, and the carotid arteries, which provide the blood supply to the brain.


"Traditionally we took these out through the skull. We would actually open up the head move the brain aside and we'd have to go around the brain and in between the brain to try to get to these tumors," says Dr. Schwartz.


Sarah couldn’t believe the diagnosis.  “A brain tumor at 28?  No, no, no. I was shocked and scared.”


But Dr. Schwartz put her at ease and offered her the newest approach to these tumors: that is, to go through her nose!


It’s called the endonasal (through the nose) endoscopic approach.  It uses a tiny scope that provides a minimally invasive way to remove tumors that until now required a large incision and opening in the skull.  “We put the scope through one nostril put our instruments through the other nostril and do the whole procedure without making any incisions in the face,” says Dr. Schwartz.


 Dr. Schwartz can get up right next to the tumor, see it much better than with the traditional surgery, and more easily remove the entire tumor, without disrupting and potentially damaging the adjacent structures.  “If we came in through the skull the first thing we would see is are the nerves and the arteries and the brain and we’d have to manipulate them to get to the tumor,” he says.


Which means for example, no risk of stroke from disrupting the carotid artery.


"Every time we do one of these cases we are very excited to do it because we are doing something that is new and different. It's great to be at the cutting edge of this," states Dr. Schwartz.


Sarah, who went home in a day and a half, feels the same way.   “To me the worse thing would be not being able to have kids. So I mean I feel good I feel good.”


The technique allows doctors to address and remove a variety of tumors and other conditions that involve this region.  This is done in just a handful of centers, but it’s slowly becoming more popular.


The patient goes home typically in two to three days rather than in five or six days.


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