Introduction
Minimally invasive surgery (also known as 'keyhole' surgery or simply by the abbreviation 'MIS') involves carrying out surgical procedures without the need to perform large incisions ('open' surgery) to access the same internal organs and tissues. Instead, smaller incisions are made whenever possible and surgery is conducted using miniaturised surgical instruments with the use of operative microscopes and endoscopic video cameras. This approach leads to less trauma to skin, bone and other muscle and soft tissue.
With minimally invasive surgery to treat brain tumours, it is often possible to give access to the brain via a craniotomy (i.e. an opening through the bone of the skull) which is less than 3 – 5 cm in diameter. When an endoscope camera is used, this is known as 'neuroendoscopy'.
Minimally invasive surgery has a number of important advantages over conventional surgery. These are…
- Less scarring to the skin – no large incisions are made; most minimally invasive surgery requires a small number of incisions.
- Muscle damage is reduced.
- Lower risk of infection.
- Lower postoperative pain.
- Lower blood loss during surgery.
- Quicker recovery times.
Indications
Minimally invasive surgical techniques for brain tumours are used to treat common brain tumour conditions, such as glioblastoma, metastases and meningiomas. However, the following rarer conditions may be particularly suitable for minimally invasive techniques:
- Colloid cysts
- Pituitary adenoma
- Cranopharyngioma
In addition, tumours affecting the skull base and the ventricles can be treated using minimally invasive surgical techniques.
Minimally invasive surgical techniques for brain tumours
A number of different MIS techniques can be used to operate on brain tumours. These include the following…
- Supraorbital eyebrow approach – this involves a small craniotomy ~2cm across, just above and to the outside of the eyebrow, to access and remove tumours located near the eyes.
- Endonasal approach – this approach involves accessing the brain via the nose, to access tumours located at the base of the skull.
- Transphenoidal approach – this approach involves accessing the brain via the sphenoid sinus, and as in the endonasal approach this is through the nasal cavity; this technique can be used to access the pituitary gland and can be used to treat pituitary adenoma, craniopharyngioma, meningioma and chordoma.
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