Endoscopic skull base surgery is a unique form of minimally invasive surgical technique to address certain lesions affecting the base of the brain between the roof of the nose and the cranial cavity containing the brain.
With the use of special instruments, surgery can be done through the nose and gain access to growths affecting the base of the brain and the brain itself. Using the nasal cavity as a natural corridor, the procedure will avoid, in selected patients, performing an open craniotomy which is incising the scalp to expose the skull then drilling it to reach the brain.
With the use of special instruments, TMC experts perform this minimally invasive surgery through the nose and gain access to growths affecting the base of the brain and the brain itself.
The Endoscopic Endonasal Approach to the skull base involves two surgeons working simultaneously to be effective since three to four hands are needed to perform this successfully. Dr. Michael Sabalza, a neurosurgeon from the Institute of the Neurological Sciences of The Medical City (TMC), and Dr. Peter Jarin, an otorhinolaryngologist and director of the ENT-Head & Neck Institute, have been performing this “true team” surgery for almost 10 years making them the pioneer in this field in the country. They have also presented the first ever series from the Philippines of their collaborative work in various local meetings and international conferences.
One of TMC’s most recent cases involved a patient in her 80s who was diagnosed with a recurring pituitary macroadenoma, a tumor found inside the skull just below the brain and nasal passages. Majority of these tumors are benign, however its position can cause health concerns as it sits close to the brain and nearby structures, as presented by the patient. The surgery was done in September 2020. The patient tolerated the procedure well and has noted a significant improvement in her condition.
In the past years, the nasal endoscope has been the game changer in sinus surgery and anterior skull base surgery. In selected tumors like pituitary adenomas, craniopharyngiomas (benign brain tumors arising near the pituitary gland) and meningiomas (a tumor that forms on membranes), access thru a sublabial (incision thru the gums) or a transseptal approach (procedure requiring retraction of the septum) with the use of the microscope has been the gold standard. However, recently this has been challenged by the endoscopic endonasal approach since it affords better visualization of the surgical field.
In pituitary surgery, data from studies have revealed comparable or even better outcomes in terms of improving vision, endocrinologic sequalae and degree of tumor resection. TMC’s own data compared Microscopic versus Endoscopic approach to pituitary adenoma where Justo et al. concluded that the endoscopic group had more patients with improved vision over the microscopic group postoperatively.
The benefits of endoscopic skull base surgery include less risk of damage to cerebral structures due to avoidance of significant brain retraction, no external incision, and a shorter recovery time. The procedure also does not require routine ICU admission.
TMC’s experience with the endoscopic transsphenoidal approach to pituitary adenomas was presented last December 2019 at the WFNS (World Federation of Neurological Sciences) meeting in Beijing China. Likewise, Dr. Sabalza’s and Dr. Jarin’s surgical series on meningioma titled “Extended Endoscopic Transsphenoidal Removal of Tuberculum Sellae Meningiomas: Illustrative Reports on the Importance of Preoperative Case Selection and Planning in Extent of Resection and Outcomes” was again presented by Dr. Jerold Justo from the Institute of Neurological Sciences last February 2020 at the 30th Annual Meeting of the North American Skull Base Society in La Cantera, Texas USA. The paper was published in the supplement of the Journal of Neurologic Surgery: Skull Base volume 81.
Endoscopic skull base surgery is now an option in TMC’s repertoire that it can offer patients to excise selected skull base tumors.
For inquiries, please call the ENT-Head and Neck Institute at 8-9881000 ext. 6251.
ADVT.