MICROSCOPIC MINIMALLY INVASIVE NEUROSURGERY
Microscopic & Endoscopic brain surgery is a procedure used primarily to treat brain tumors. It is considered a minimally invasive brain surgery that allows neurosurgeons to identify and treat conditions that are deep within the brain.
“This type of surgery allows us to treat brain tumors less invasively than traditional open brain surgery, while still affording us the ability to get an in-depth view of the brain,” says Dr. Asif Bashir
During this procedure, thin tubing that transmits video images of the brain is inserted through one or two small incisions in the skull or through an opening in the body. This tube-like instrument, called an endoscope, contains a small camera that allows the neurosurgeon to see detailed images of the problem area in the brain.
“Endoscopic approaches have truly transformed how we treat tumors, particularly because endoscopic techniques give us such a clear visualization of the tumor,” says Dr. Asif Bashir. “This approach also does not always require us to access the brain through the skull. We’re able to access the brain through pathways like the nose and sinuses as well.”
The neurosurgeon will use the images transmitted by the endoscope as a guide for removing the tumor or repair the affected area of the patient’s brain. The removal of the tumor or damaged area is performed with specialized surgical instruments.
Possible Risks involved:
- Temporary or permanent interference with sensory and motor functions like speech, vision, memory, balance, coordination, etc.
- Blood clot
“While the likelihood of a patient experiencing these complications is rare, I believe in strong patient-doctor communication, so each patient understands their procedure and the risks associated,” Dr. Asif Bashir, Best Neurosurgeon in Pakistan
The Benefits of Endoscopic Brain Surgery:
Endoscopic brain surgery offers many benefits to patients. This type of surgery is less invasive than other open surgery procedures, offering a faster recovery period and less pain for the patient.
While each patient’s medical history, age, condition and other factors play a role in the outcome of endoscopic brain surgery, here are some of common benefits associated with the procedure:
- Minimally invasive (results in less pain for the patient)
- Faster recovery time than open brain surgery
- Reduced risk of brain trauma
- Reduced risk of side effects
- Reduced hospital stay
Microscopic & Endoscopic Minimally Invasive surgery is the latest & non.destructive technique performed by Dr. Asif Bashir for the following conditions:
- THIRD VENTRICULOSTOMY FOR HYDROCEPHALUS
- INTRACRANIAL ANEURYSM CLIPPING
- BRAIN & SPINAL TUMORS
- SPINE SLIPPED DISC SURGERY
- KEY HOLE MINIMALLY INVASIVE SPINE SURGERY
- INTRAVENTRICULAR BRAIN TUMORS
- COLLOID CYST
- CEREBROSPINAL FLUID FISTULA: CSF FISTULA LEADING TO CSF RHINORRHEA
- PEDIATRIC NEUROSURGERY
- PITUITARY ADENOMA TUMOR
- ARACHNOID CYST
Intracranial Surgery: In intracranial surgery, endoscopes are introduced into the brain through very small skull openings, following which tiny instruments may be placed through the same opening for the purpose of performing endoscopic tumor biopsy, colloid cyst resection, and endoscopic cyst fenestration, as well as to treat hydrocephalus. Operations can last from about 15 minutes to an hour, and patients are typically discharged the next day from the hospital.
Endonasal Neurosurgery: Endonasal (through the nose) neurosurgery is frequently performed to treat a range of conditions, included among which are pituitary tumors, meningiomas and chordomas. Prof. Dr. Asif Bashir is able to maneuver the endoscope to different areas, which allows treatment of brain tumors in different locations. He can also direct the endoscope downward and clearly see the palate and the back of the throat to operate on the top of the spine and base of the skull.
Endoscopic neurosurgical procedures have been used in the treatment of pituitary tumours, hydrocephalus, intracranial cysts, intraventricular brain tumors, lumbar discectomy and decompression for lumbar spinal stenosis and Pediatric neurosurgery in children, Cerebrospinal Fluid CSF Fistula leading to rhinorrhea.
"CRANIAL ENDOSCOPIC PROCEDURES"
1. ENDONASAL PITUITARY SURGERY:
Endoscopic pituitary surgery also called as Endonasal Transsphenoidal Endoscopic Pituitary Adenoma Surgery is performed through a natural nasal air pathway through the nose without any incisions unlike the conventional microscopic surgery performed with an incision made under the upper lip or inner aspect of a nostril. Endoscopic surgery does not require the use of a metallic transsphenoidal retractor that is used for conventional Microscopic Transnasal Transphenoidal Pituitary Tumor surgery. Combined Endonasal Microscopic & Endoscopic Pituitary is also done through the nose with non.destructive techniques. A 4-mm endoscope is placed in front of the tumor in the sphenoidal sinus and the tumor is removed with specially designed surgical tools. Postoperative nasal packing is not necessary, and postoperative discomfort is minimal. Most patients are able to go home the following day. The optical advantages of an endoscope (such as a wide-angled panoramic view, an angled view by angled lens endoscopes, and a view in the tumor removal cavity) enhance tumor removal even in complex cases of bulky tumors.
Advantages of Endoscopic Pituitary Surgery
- With this newly developed minimally invasive technique, pituitary tumors can be removed through the patient's natural nose.
- This procedure does not require sublabial or nostril incisions and eliminates the need for occlusive postoperative packing used with the conventional procedures.
- This method is minimally invasive because it directly approaches the tumor through the patient's nostril thus eliminating facial swelling, decreasing postoperative pain, and making recovery quicker.
- The procedure is innovative because it utilizes endoscopic technology to improve visualization of the pituitary gland, the tumor, and other anatomical structures.
2. ENDOSCOPIC MINIMALLY INVASIVE SURGERY FOR TREATMENT OF HYDROCEPHALUS
Hydrocephalus a condition in which the normal circulatory pathways of cerebrospinal fluid (CSF) are altered. Hydrocephalus can result from a number of conditions including congenital malformations, infection, hemorrhage, or brain tumors. With the accumulation of CSF, the intracranial pressure increases resulting in symptoms such as headache, vomiting, altered personality, and decreased cognitive performance. Hydrocephalus was perniciously treated by VP and VA shunts which had a significant rate of failure requiring frequent hospitalizations and additional surgery.
In patients with noncommunicating hydrocephalus, endoscopic third ventriculostomy (ETV) can be used to bypass the site of cerebrospinal fluid (CSF) obstruction. ETV is a technique that redirects the flow of CSF by creating a small fenestration or opening in the floor of the third ventricle.
Endoscopic Third Ventriculostomy (ETV)
The procedure is performed through a small incision (approximately 1 inch) behind the hairline. From this site, the endoscope is inserted into the ventricular compartment of the brain and then navigated into the third ventricle. The floor of this compartment is then fenestrated, or opened. The endoscope is then removed and the wound is closed. The procedure is performed in approximately 30 minutes and patients can return home the following day.
The obvious advantage of this procedure is that no implanted shunt is needed thus avoiding the potential long-term risks of shunts including infection, migration, or disconnection.
3. ENDOSCOPIC MINIMALLY INVASIVE SURGICAL MANAGEMENT OF INTRAVENTRICULAR BRAIN TUMOURS
The cerebral ventricles are chambers within the brain that contain a clear-colorless fluid called cerebrospinal fluid (CSF). CSF serves as an excellent medium for endoscopy given the clarity and space. Since many varieties of brain tumors can occur in the ventricles, biopsy is commonly recommended in order to define the best type of therapy. Conventional procedures for tumor biopsy involve either a needle biopsy using a frame attached to the skull or an open surgical procedure. Brain tumors situated in the intraventricular compartment are amenable to an endoscopic biopsy or resection.
Endoscopic Tumor Surgery
The procedure is performed through a small incision (approximately 1 inch) behind the hairline. From this site, the endoscope is inserted into the ventricular compartment of the brain and then navigated toward the tumor. The tumor is readily identified due to the difference in appearance from the surrounding tissue. Biopsy forceps are then used to sample the tumor. Because direct vision is being used, samples can be selected avoiding any small blood vessels or other important structures within the ventricle, features thatcannot be done with standard "closed" needle biopsies. The endoscope is then removed and the wound is closed. The procedure is performed in approximately 30 minutes and patients can return home the following day.
Endoscopic biopsy for intraventricular brain tumors avoids many of the inherent risks associated with conventional surgical approaches. Because these tumors are typically situated deep within the brain, the ability to approach these tumors with a minimallyinvasive technique offers a very significant advantage to the patient.
4. ENDOSCOPIC MINIMALLY INVASIVE SURGERY FOR EXCISION OF COLLOID CYSTS
ENDOSCOPIC EXCISION OF COLLOID CYSTS
The most common tumor located within the third ventricle is the colloid cyst. This benign tumor can cause a blockage of cerebrospinal fluid (CSF) leading toward increased intracranial pressure and potentially death. The definitive method for treating colloid cysts is surgical removal. Prior to the advent of endoscopic neurosurgery, the removal of colloid cysts relied on an extensive open surgical procedure achieved by way of a craniotomy, an open procedure which requires removal of a portion of the skull.
Colloid Cyst Resection
The procedure is performed through a small incision (approximately 1 inch) behind the hairline. From this site, the endoscope is inserted into the ventricular compartment of the brain and then navigated toward the tumor surface. The wall of the tumor is then coagulated with an electrical current and the cyst is then opened with sharp dissection. A variety of suction catheters are then used to empty the contents of the cyst. The cyst wall is then removed and any remnants are destroyed using an electrical current. The endoscope is then removed and the wound is closed. The procedure averages 45 minutes-1 hour and patients can return home within 1-2 days Because of the deep and central location of these benign tumors the standard surgical procedures are usually lengthy and have significant risk. Highly refined endoscopes with a wide array of compatible instruments allow complete removal of colloid cysts through a much less invasive technique in a fraction of the time.
5. ENDOSCOPIC MINIMALLY INVASIVE SURGERY FOR TREATMENT OF ARACHNOID CYSTS
ENDOSCOPIC TREATMENT OF ARACHNOID CYSTS
Developmental cysts of the brain, or arachnoid cysts, cause symptoms based upon the location and size of the cyst. Weakness decreased cognitive performance, spontaneous hemorrhage, and seizures, are common presentations for individuals with intracranial arachnoid cysts. Most common locations include the temporal fossa, the posterior fossa, and the suprasellar region. Treatment has typically involved either the placement of a permanent drainage system (cystoperitoneal shunt) or an open surgical procedure to fenestrate the walls of the cyst. Cyst fenestration is typically favored due to the high success rate of this procedure. However, shunt placement is appealing due to the simplicity of the operation.
Endoscopic Cyst Fenestration
The procedure is performed through a small incision (approximately 1 inch), the location being dictated based upon the location of the cyst. From this site, the endoscope is inserted into the cyst and the wall of the cyst is then opened into one of the natural fluid chambers of the brain. With this opening, the fluid can then exit the cyst and get absorbed through normal means. This procedure averages 30 minutes to 1 hour and patients can return home the following day.
Endoscopic cyst fenestration is a technique that couples the minimally invasive benefits of shunting with the advantage of open fenestration by avoiding shunt implantation.
6. ENDOSCOPIC MINIMALLY INVASIVE SURGERY TREATMENT OF CEREBROSPINAL FLUID FISTULA / CSF FISTULA
Cerebrospinal fluid Fistula also called as CSF Leak means leakage of clear Fluid like water from the nostrils and it is usually secondary to trauma to head or sometimes it is spontaneous without any cause. This fluid is infact coming from the cranial cavity where it is in a water tight covering which protects it from getting infected. Due to breach or fracture in the bone at the base of skull creats an opening leading to this leak and it also creats a communication between the cranial cavity and external envoirnment giving chance to bacteria to infect the cranial cavity leading to Meningitis. The biggest hazard of CSF Fistula is severe Fulminant Meningitis leading to death. It should be immediately treated and the communication be closed leading to stoppage of CSF leak andprotecting the brain from bacteria
ENDOSCOPIC CLOSURE OF FISTULA USING THE LATEST TECHNIQUE THROUGH THE NOSE WITHOUT OPENING THE SKULL. ONLY 24 HOURS STAY IN THE HOSPITAL AND WITHOUT ANY EXTERNAL INCISION OR SCAR MARK.