Navigation Links
Researchers quantify benefits of minimally invasive removal of hard-to-reach tumors

CINCINNATIA minimally invasive endoscopic procedure holds promise for safely removing large brain tumors from an area at the bottom of the skull, near the sinus cavities, clinical researchers at the Brain Tumor Center at the University of Cincinnati Neuroscience Institute (UCNI) at University Hospital have found.

The findings, to be published in the April 2010 issue of the Journal of Neurosurgery and previously published online in October 2009, have important implications for patients with large pituitary tumors (pituitary macroadenomas).

"This is the first time that a quantitative advantage has been shown for the use of endoscopy in cranial surgery," says Philip Theodosopoulos, MD, principal investigator of the study, director of skull base surgery at UC and a neurosurgeon with the Mayfield Clinic.

"This signals the dawn of a new era in minimally invasive cranial surgery. We have moved from the realm of assessing whether it is feasible to studying its clinical effectiveness. In this way, it is slowly starting to change from a novelty to standard treatment, setting the bar for the quality of surgical outcomes higher than ever before."

Although tumors of the pituitary gland, located near the base of the skull, are benign, pituitary macroadenomas can wreak havoc, causing acromegaly (an overproduction of growth hormone), Cushing disease (an overproduction of the hormone cortisol) and hyperthyroidism, as well as visual problems, headaches and dizziness.

When removing pituitary macroadenomas (tumors that are larger than 10 millimeters), surgeons have employed three distinct routes to the tumor:

  • Through the skull, in a procedure called a craniotomy.
  • Through an incision under the upper lip and then through the septum, which must be split apart.
  • Through the nostrils -- a transnasal approach -- without an incision.

The endoscopic transsphenoidal approach, Theodosopoulos says, follows natural anatomical corridors and causes less disruption of nasal tissues. This approach, as the new study reveals, also holds benefits related to complete tumor removal, which is important for the patient's quality of life.

Removing an entire pituitary macroadenoma can be difficult because the tumor's growth pattern can cause it to extend through the sinus corridor, which is out of the surgeon's view.

Surgeons can ensure that the entire tumor has been removed if their hospital operating room is equipped with a technology known as intraoperative MRI, or ioMRI. The surgery-prolonging technology enables surgeons to take MRI scans while the patient is still under anesthesia and on the operating table. The UC Neuroscience Institute at University Hospital has had ioMRI since 1999, but the expensive technology is not available at most hospitals.

An endoscopic approach, by contrast, allows the surgeon to check for remaining tumor with "intrasellar endoscopy." Using a tiny, sophisticated camera on an angled endoscope, the surgeon can peer around bends and into crevasses to identify any remaining tumor. "The endoscopic approach holds the potential for less invasive treatment for all patients and more complete tumor resections for individuals treated in hospitals without access to intraoperative MRI," Theodosopoulos says.

During the retrospective study at University Hospital, the team analyzed surgical outcomes of 27 consecutive patients between 2005 and 2007 who had undergone endoscopic removal of pituitary macroadenomas. The search for unexpected residual tumor was conducted two ways in all patients: first with the tiny endoscopic camera (intrasellar endoscopy) and then with intraoperative MRI.

Following the initial endoscopic tumor removal, intrasellar endoscopy revealed that 23 of the 27 patients (85 percent) had no unexpected residual tumor. Surgeons were able to safely perform additional surgery on three of the four patients who had unacceptable residual tumor.

Following the endoscopic procedures, all patients were checked with intraoperative MRI, which revealed that tumor removal was successful in 26 patients (96 percent).

The study results show that maximum tumor removal can be successfully achieved with endoscopy and without intraoperative MRI, Theodosopoulos says. He adds, however, that the findings could be strengthened by a larger study.


Contact: Cindy Starr
University of Cincinnati Academic Health Center

Related medicine news :

1. Researchers design self-test for memory disorders
2. Researchers identify potential new target for treating hepatitis C
3. Researchers Identify 2 Genes Linked to Fatty Liver Disease
4. NIA researchers find gene to explain mouse embryonic stem cell immortality
5. Researchers discover fundamental step in immune-system development
6. Scott & White Healthcare researchers studying investigational agent that targets breast cancer
7. SRI International Researchers to Present Work on Early Detection Tool for Neglected Tropical Diseases at 2010 American Chemical Society (ACS) Meeting
8. Researchers find new chemotherapy combination shows promise in endometrial cancer
9. Researchers ID brain abnormalities in children exposed to methamphetamine in utero
10. Mount Sinai researchers are the first to identify heart abnormalities in World Trade Center workers
11. Researchers discover chemical that may protect hearts of muscular dystrophy patients
Post Your Comments:
(Date:10/13/2015)... , ... October 13, 2015 , ... ... companies in the United States, today announced the release of its limited edition ... new Cranberry Cocktail Agua Fresca. All feature the unique flavor combinations and delicious ...
(Date:10/13/2015)... ... October 13, 2015 , ... ... announced today their sponsorship of the Microsoft Dynamics AXUG, GPUG and NAVUG Summits ... GPUG Summit and NAVUG Summit are independent user conferences designed and led by ...
(Date:10/13/2015)... ... October 13, 2015 , ... Dr. Poneh Ghasri, dentist ... on September 18, 2015. The research, which was conducted at the Dental Institute at ... colleagues, show connections between stress during pregnancy and future dental health in the child. ...
(Date:10/13/2015)... ... ... Protein is essential to good health. You need it to make the bricks ... does the average man need in order to stay healthy? , The answer ... Harvard Men's Health Watch . Most Americans get about 15% of their calories ...
(Date:10/13/2015)... ... October 13, 2015 , ... Georgia Partnership ... in communities throughout Georgia, along with affiliate organizations, Alabama Partnership for Telehalth (ATP) ... telehealth summits for Fall 2015. , Each of the three conferences share ...
Breaking Medicine News(10 mins):
(Date:10/13/2015)... DIEGO , October 13, 2015 ... today announced the appointment of Harry Lander , PhD ... the Company,s Chairman & CEO David Koos as ... small molecule and immuno-oncological therapeutics. --> Regen ... the appointment of Harry Lander , PhD as its ...
(Date:10/13/2015)...  Yesterday Congresswoman Renee Ellmers (R-NC-02) visited ... located in Holly Springs, NC . ... ® (Influenza Vaccine) using cell-culture technology, a state-of-the-art production ... is not reliant on chicken eggs. 1,2 On ... business of Novartis AG in the US, which for ...
(Date:10/12/2015)... 12, 2015 Given the intricacy of ... challenging to deliver an ophthalmic drug effectively to a specific ... successful ocular drug delivery. These include dilution of a drug ... of conjunctiva and drug permeation issues with respect to the ... topical eye drops, is lost due to the aforementioned barriers. ...
Breaking Medicine Technology: