More Options for Less Invasive Brain Tumor Surgery

April 15 (HealthDay News) -- The type of brain tumor can determine whether entry through the nose or the eyebrow is the best approach for minimally invasive "keyhole" surgery to remove the tumor, a new study finds.

Both approaches have advantages over traditional open-skull surgery, such as far less bone removal, brain exposure and brain retraction. Patients who have the minimally invasive surgeries typically recover faster and have excellent outcomes, according to background information in the study. But it hasn't been easy to determine which minimally invasive technique is best for a particular patient.

"With recent advances in micro-instrumentation, endoscopy for visualization and computerized surgical navigation, keyhole approaches are often used to remove brain tumors traditionally requiring much larger, more extensive craniotomies," study senior author Dr. Daniel F. Kelly, medical director of the Brain Tumor Center at Saint John's Health Center, Santa Monica, Calif., said in a news release.

"Going through the nose or eyebrow gives surgeons two very different minimally invasive routes to reach the same intracranial region," Kelly said. "Until now, no one has done an ongoing comparison of these two approaches. Our experience suggests that, in many cases, either route can be used, but for particular tumor types, the eyebrow route had advantages over the endonasal, and vice versa."

The study included 43 patients with benign brain tumors called craniopharyngiomas (22 patients) or meningiomas (21 patients). Both types of tumors arise in the skull base near the optic nerves and pituitary gland and can cause problem such as vision loss and hormonal dysfunction.

"We found that most craniopharyngiomas can be approached from below, through the nose, while large meningiomas are best approached from above, through the eyebrow," said Kelly, who added that "surgeon experience and the specific tumor anatomy will be the deciding factors in choosing the best approach."

The study is published in the May issue of Operative Neurosurgery.

SOURCE: Saint John's Health Center, news release, April 14, 2009

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