Not long ago, growths and abnormalities occurring along the base of the skull and brain and at the very top of the spinal column, collectively called the “skull base,” could be treated only by making a surgical opening in the skull (called a transcranial approach) and, frequently, the face (transfacial approach). These approaches can be quite invasive, placing the patient at risk of complications. A breakthrough in skull base surgery is endoscopic endonasal surgery, a minimally-invasive technique for the removal of select abnormalities that grow along the skull base. Working through the nose with specially-designed endoscopic instruments and a tiny, high-definition endoscope (camera), tumors can be removed with superior accuracy, fewer complications and no incisions to the head or face.
Given its small size and angling options, the neuro-endoscope can also be used to maximize tumor resections during a standard transcranial approach in what is called endoscope-assisted tumor surgery. Capable of producing a clear, high-definition image even in fluid, the endoscope can be used to operate deep within the ventricles (fluid-filled spaces) of the brain. With this application, tumors within the ventricles can be biopsied or removed and new pathways opened for restoration of cerebrospinal fluid circulation when normal blood flow has been lost.
While this type of surgery may not work for every condition, it allows patients to avoid the risks, pain and long recovery times associated with open surgery. Board Eligible and fellowship-educated neurosurgeon Dr. Jacob Freeman has specialized training and experience in endoscopic skull base surgery, as well as a host of other neurosurgical procedures. Dr. Freeman and the rest of the Ocala Neurosurgical Center medical team first perform advanced diagnostic testing to determine the location and nature of the problem, and then to formulate a treatment plan.
Abnormalities treated with these advanced techniques include benign and malignant tumors, infection, cysts, hydrocephalus and others. There are many blood vessels, nerves, muscles, bones and cavities in and around the skull, so symptoms can vary depending on the cause, size and location of the defect. Symptoms may include pain, numbness, weakness, visual disturbances, nasal congestion, nasal or ear infections, dizziness, nausea, ringing in the ears, hearing loss and other problems.
“Neuro-endoscopic surgery has revolutionized the way we approach and resect certain tumors of the brain and skull base,” says Dr. Freeman. “For many patients, it means less pain and faster recovery.”
Though it is easier and safer than traditional open surgery for certain lesions, endoscopic brain tumor surgery requires a multidisciplinary team of specialists to perform. “ONC has a highly experienced and talented team who will work with other specialists in the area to ensure the best possible outcome for each patient we treat,” states Dr. Freeman. For more complex tumors involving the brain and nasal sinuses, Dr. Freeman says, “We combine the endoscopic endonasal approach with one or more traditional open approaches to maximize our resection and improve outcomes. We always endeavor to use the least number of entry points to adequately address the issue so we can reduce the chance of infection and improve recovery.”
Depending on the problem, additional remedies may be indicated. Says Dr. Freeman, “When needed, I communicate directly with a patient’s referring physician to help compose a comprehensive treatment plan and follow-up course to promote the best and longest-lasting result.”