Endoscopic skull base surgery

Definition

Endoscopic skull base surgery is a multidisciplinary approach (typically involving neurosurgeons, otolaryngologists, and others) that consists of a group of techniques to access hard-to-reach areas around the base of the brain. An endoscope, or surgical telescope, is used to provide a crisp, high-definition view of the surgical area, while specialized instruments are used to assist surgeons in everything from tumor removal, to biopsies, to repairs of cerebrospinal fluid leaks.

UF Health is the premier institution in the state of Florida with a program focused on benign and malignant skull base tumors, cerebrospinal fluid leaks, and the UF Health Comprehensive Skull Base Surgery Center is home to physicians expertly trained to perform endoscopic surgeries. In fact, U.S. News and World Report just ranked UF Otolaryngology No. 1 in Florida and No. 25 in the United States. We are proud to have these members as part of our multidisciplinary team.

Brian Lobo, MD operating with an endoscope

What is the Procedure Used For

This procedure can treat a wide range of conditions, including:

For most tumors, this approach is used to access, remove, and reconstruct the area of interest; however, at times, this approach is used to obtain a small tissue specimen, called a biopsy, which is used to guide further therapy.

How the Procedure is Performed

Typically, these procedures are performed under general anesthesia, using our team of specialty neuro-anesthesiologists. After preparing the patient for surgery, including the use of leading-edge intra-operative navigation, the team of surgeons will use a high-definition camera and specialized instruments to remove portions of the sinus cavity, much like tearing down walls while remodeling a house. This creates a large, wide-open conduit to access areas around sinuses, eye sockets and even the spine. Occasionally, a small, external excision in the mouth or face is used in combination with the normal, minimally invasive approach through the nostrils or mouth.

Steven Roper, MD performs endoscopic surgery

Once access has been created, the team of surgeons will then, when necessary, remove tumors or masses in the skull base, the area where the brain rests on the floor of the skull. Once the tumor has been removed, the conduit is then repaired, closing off the brain space from the sinus cavity. Tissue from inside the nose, called a nasoseptal flap, is often used, along with tissue from other sites of the body to create a multi-layer repair that will prevent brain fluid from leaking out of the repair.

UF Health endoscopic skull base specialists utilize the endoscopic endonasal approach, a specific type of endoscopic skull base approach, to remove tumors all the way from the front of the brain to the top of the spine, often without any external facial incisions. This method enables the UF Health Comprehensive Skull Base Surgery team to access and treat tumors that often require extremely invasive approaches, even now in centers without specially experienced or fellowship-trained surgeons.

Endoscopic skull base surgery requires a team of specialists that may include otolaryngologists (commonly referred to as ENT surgeons), maxillofacial surgeons, neurosurgeons and radiologists.

Benefits of the Procedure

The endoscopic approach can be especially useful for tumors, aneurysms, CSF leaks, and other diseases of the skull base. Because this area is crowded with so many vital structures, and due to the difficulty in accessing skull base lesions, traditional or open surgery is not always ideal. The endoscopic camera offers a magnified view of the tumor and structures around it, and the camera relays images to multiple large monitors in the operating room to guide the surgeons. In addition, our state-of-the-art intraoperative navigation allows for real-time radiologic guidance, and our dedicated intraoperative MRI suite allows for assessment of progress of tumor resection in situations where this is appropriate.

Importantly, the endoscopic minimally invasive approach allows for shorter recovery times and inpatient stays. This is due to the decreased need to place pressure on the brain, the decreased need to make large incisions on the face and neck, and the ability of our specialized surgeons to reconstruct the internal defects created when approaching the tumors. It also has the benefit of fewer complications, reduced blood loss and no visible scars.

However, in some situations, traditional open surgery may be more appropriate, and radiation, proton therapy or radiation are also often used.

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