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21st Century Brain Surgery: Minimally Invasive Endonasal Approach, Experienced Surgeons Give Patients the Advantages They Need

Posted on: 12/11/2008


Press Release Source: Saint Johns Health Center


21st Century Brain Surgery: Minimally Invasive Endonasal Approach, Experienced Surgeons Give Patients the Advantages They Need
Monday December 8, 8:00 am ET


SANTA MONICA, Calif.--(BUSINESS WIRE)--Being diagnosed with a brain tumor can be devastating news. But thanks to a decade of advances in minimally invasive surgical procedures and improvements in instrumentation, patients today have a far better chance of recovery—without the risks of traditional “open-skull” surgery or other techniques.


A study published in the October 2008 issue of Operative Neurosurgery, evaluated operations performed by a single surgeon over 10 years and found that when a surgeon is equipped with sophisticated instruments and extensive experience, minimally invasive procedures can be used to remove certain brain tumors through the nose, both safely and effectively. The study focused on 812 patients, most with pituitary adenomas (a non-cancerous yet dangerous tumor of the brain), all of whom were operated on by Daniel F. Kelly, M.D., Director of the Brain Tumor Center at Saint John’s Health Center.


Dr. Kelly is a specialist in endonasal transsphenoidal surgery, a minimally invasive procedure that allows doctors to use a natural opening—a nostril—to access the pituitary gland and surrounding area. Earlier surgical strategies included cutting through the skull (craniotomy), or making an incision under the upper lip. This latter procedure, called sublabial transsphenoidal surgery, has major drawbacks including pain caused by the incision and lip retraction; in addition, numbness of the upper lip is a frequent side effect. Also, the nasal cavity must be packed with gauze for several days after surgery, adding to the patient’s discomfort.

“As our previous studies have shown, most patients prefer the idea of a minimally invasive procedure that can be carried out through a natural opening rather than an incision,” Dr. Kelly says.

For endonasal surgery, Dr. Kelly utilizes an operating microscope for light and magnification, as well as a thin, lighted tube called an endoscope. Inserted directly into the nostril, the endoscope provides a panoramic “inside view” of the surgical area. Miniaturized surgical instruments are also inserted through the nostril, passing through a butterfly-shaped bone at the base of the skull to reach the tumor.

“Together, the combined microscopic and endoscopic approach allows the safe and effective removal of pituitary adenomas, as well as many other brain tumors traditionally removed by craniotomy,” Dr. Kelly said.

The study confirms two themes in modern surgery. First, that advances in technology and instrumentation are allowing surgeons to perform operations more safely and effectively through smaller openings. Second, as a surgeon’s experience grows, patient outcomes improve and complication rates go down. “Avoiding complications is paramount in any procedure,” Dr. Kelly said. “Clearly, surgeons need to focus on less invasive techniques and gain expertise to achieve the best possible results.”

Almost 20% of the surgeries performed in the study involved a reoperation, a second procedure that was required after the patient had undergone surgery elsewhere. The problem, Dr. Kelly explained, is that when surgeons work without advanced equipment and sufficient experience, they may miss residual tumor tissue that is otherwise accessible. This can ultimately result in another operation, radiotherapy, or other potentially avoidable complications.

“Patients who need brain tumor surgery are best off at a high-volume center of excellence,” Dr. Kelly said. “Don’t be afraid to search for a surgeon with outstanding skills and experience, so that you have a chance for the best possible outcome.”

Saint John’s Health Center

Since its founding in 1942 by the Sisters of Charity of Leavenworth, Saint John’s Health Center has been providing the patients and families of Santa Monica, West Los Angeles and ocean communities with compassionate, advanced medical care. Saint John’s provides a spectrum of treatment and diagnostic services with distinguished areas of excellence in cancer care, cardiac care, orthopedics, women’s health and specialized programs such as the internationally acclaimed John Wayne Cancer Institute. Saint John’s Health Center is dedicated to bringing to the community the most innovative advances in medicine and technology.

Brain Tumor Center

The Brain Tumor Center at Saint John’s Health Center provides comprehensive care, minimally invasive surgery and support for patients with brain tumors, skull base tumors and pituitary adenomas.

Nasrin Fatemi, Joshua R. Dusick, Manoel A. de Paiva Neto, and Daniel F. Kelly. The Endonasal Microscopic Approach for Pituitary Adenomas and Other Parasellar Tumors: A 10-Year Experience. Neurosurgery 63 [Operative Neurosurgery Suppl 2]:ONS244-ONS256, 2008.



Saint John’s Health Center
Greg Harrison, 310-829-8010
858-472-5560 (cell)

Source: Saint Johns Health Center


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