Endoscopic Surgery

How Endoscopic Surgery Revolutionalised Access to Brain Tumours.

Resection of brain tumours has been a challenge for neurosurgeons.

This challenge is more prominent when a tumour located at the skull base as access is very limited and even advances in microsurgical techniques have not eliminated the need for major operation through the skull to get access to these tumours.

Although the outcome of open surgery for skull base tumours has been gradually improved over the last few decades, access to these kinds of tumours through open surgery carries a significant risk of damaging normal brain tissue, nerves and vasculature considering how deeply these tumours located.

Thanks to significant improvements in endoscopic surgery over the last few years, there is less need for open surgery as these deeply located tumours can get approached and resected through the nasal cavity.

Tumours like Meningioma, Craniopharyngioma, Chordoma, Pituitary tumours and malignant skull base tumour can be resected using this endoscopic technique known as Endoscopic endonasal transsphenoidal surgery.

There would be no incision or scar to be seen as the entire operation is through the nasal cavity and also a risk of damage to normal neuronal tissue is minimized as this technique provides direct access to a tumour without needing to go through normal brain tissue.

Furthermore, this technique can provide a minimally invasive access to the upper part of the cervical spine, which would be needed for some of the pathologies located at this area, reducing the need for open procedures.

Same as other surgical techniques, there are some limitations to consider for endoscopic operation but with good case selections, we have achieved a very good result for these challenging tumours.

I have been using this endoscopic technique in England where I acquired satisfactory experience in this field and managed to set up my endoscopic skull base course at Leeds to train other neurosurgeons with interest in skull base neurosurgery.

Since I have joined Neuron, managed to use the state of art endoscopic equipment and instruments to offer this kind of operations at Brisbane Private Hospital.

I have also been using my endoscopic experience for open lateral skull base operations such as resection of acoustic neuroma, meningioma, epidermoid and microvascular decompression of trigeminal and facial nerve when needed to get the advantage of expanded vision endoscope can provide during these open procedures.

Dr Ali Alavi

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