8 WAYS WE STRIVE TO MAKE SURGERY SAFER & MORE EFFECTIVE

Maximizing tumor removal and avoiding complications are two key goals of any tumor removal surgery. In addition to our accumulated skills and experience, we utilize a variety of techniques and technologies to help achieve these goals. Here are 8 such methods we frequently use depending upon the specifics of a given patient.

1.

Surgical Navigation (“GPS for the brain”): Before surgery a navigational MRI is performed that is then incorporated into a tracking system in the operating room such that a probe placed on the scalp, skull or brain can be precisely localized within millimeters. This intra-operative “GPS” methodology is used on all cases to help define the ideal scalp incision, bony opening, critical nerves and vessels and the tumor itself.

2.

Functional MRI & Fiber Tractography: Before surgery a special MRI is performed to determine where critical functions (e.g., motor or language) or critical fiber tracts (e.g., motor or visual tracts) are located in relation to a tumor. Having this information before surgery, helps select the safest corridor to the tumor.

3.

Ultrasound for Tumor Localization: Tumors that are below the brain surface can at times be difficult to find even with surgical navigation due to shifting of the brain after the dura (brain covering) is open. In contrast, an ultrasound probe provides a simple safe real-time image of the brain that can precisely localize deeply situated tumors or those in or under critical brain areas such as the motor cortex.

4.

Ultrasound for Tracking Critical Blood Vessels: Many brain and skull base tumors become intimately attached to critical arteries and veins. Preserving such vessels is essential to avoiding a post-operative stroke. The slender thin Doppler probe provides an accurate real-time method of localizing such vessels that may be hidden directly behind a rind of tumor or dural membrane. The Doppler probe is an essential tool used in every endonasal endoscopic surgery and many craniotomies to avoid vascular injury.

5.

Endoscopy: The panoramic highly detailed view of the high-definition surgical endoscope is in many ways superior to the operating microscope. Thus it has replaced the microscope as the sole viewing choice in well over 80% of our endonasal and skull base tumor surgeries. The endoscope is also used in most craniotomies to confirm complete or maximal tumor removal and to help with tumor removal itself.

6.

Evoked Potential Monitoring (electrical neuro-monitoring): Removal of many brain and skull base tumors may involve manipulation of fiber tracts, cranial nerves and blood vessels. Neuro-monitoring allows us to electrically track the degree of neural and blood vessel manipulation and serves as an early warning system that a nerve or blood vessel may be overly stressed or damaged. Such neuro-monitoring helps as a means of avoiding neurological complications such as stroke, paralysis and sensory loss.

7.

Cerebrospinal Leak Repair Protocol: One of the most common complications of endonasal endoscopic surgery and other skull base surgeries is post-operative cerebrospinal fluid (CSF) leak which can lead to serious problems such as bacterial meningitis and reoperation. We have a long track record in the repair and avoidance of such CSF leaks and have utilized a graded repair protocol and close post-operative surveillance that have reduced our overall post-operative CSF leak rate to 1%.

8.

Post-operative Imaging & Monitoring: Careful and frequent surveillance of patients after tumor removal is routine. Patients typically have post-operative imaging (a CT or MRI scan) to assess for any immediate post-operative problems such as bleeding and are carefully monitored in our Saint John’s Intensive Care Unit or Step-Down Unit. Our team, including nurse practitioner, neurosurgical fellow, hospitalist and ICU nursing staff carefully monitor patient recovery.