Logo: Center for Minimally Invasive Skull Base Surgery

The role of minimally invasive skull base (MISB) surgery is expanding in the management of benign and malignant tumors of the paranasal sinuses, skull base and intracranial lesions.

About

About Minimally Invasive Skull Base Surgery

The role of minimally invasive skull base (MISB) surgery is expanding in the management of benign and malignant tumors of the paranasal sinuses, skull base and intracranial lesions. MISB surgery uses an endoscope - a long, flexible instrument attached to a camera and a light source - to guide surgeons through very small ports of entry to remove these tumors. These procedures involve very small or no incisions, resulting in fewer complications, reduced blood loss, and shorter recovery times for patients.

The most common approach is through the nose (an endonasal corridor) and involves the combined efforts of an otolaryngologist and a neurosurgeon in the operating room. In the future, these techniques may be expanded to the lateral skull base and the adjacent spine.

Advantages of endoscopic techniques for skull base lesions:

While larger lesions may still require open surgical approaches, the true number of tumors that can be approached with minimally invasive techniques has yet to be determined. Recently, a team at UCSF has applied these techniques to procedures on the surgical spine in a successful effort to avoid large incisions in the palate, tongue, and jaw.

The main focus of the developing field of MISB surgery is on endonasal approaches to the anterior and central skull base. The genesis of this field was centered around transnasal pituitary surgery due to the high volume of pituitary lesions and easy application of endoscopic technology. However, expanded endoscopic approaches have several other applications. There is a developing field of endoneurosurgery that does not involve transnasal approaches. In the future, endoscopic minimally invasive technology may be applicable to lesions in the lateral skull base and upper cervical spine.

While many patients are interested in minimally invasive approaches, not all are candidates for these approaches and many will require traditional open approaches. In order to provide optimal care to patients, at UCSF we offer a program capable of providing the full range of open and endoscopic surgical options for tumor resection. Optimal care is achieved by proper patient selection, and a multidisciplinary approach involving neuroradiology, radiation oncology, neuro-oncology and medical oncology, neuroendocrinology, and speech and swallow pathology.


The view through the endoscope while removing a chordoma:



Minimally invasive removal of a suprasellar Rathke's cleft cyst:



Minimally invasive removal of a tuberculum sella meningioma:

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