Expanded endonasal approach surgery removes tumors once deemed to be inoperable

A first-of-its-kind study published in the February issue of the Journal of Neurosurgery: Pediatrics suggests endoscopic brain surgery, pioneered by surgeons at the University of Pittsburgh Medical Center, has the potential to be safer and often more effective than conventional surgery in children with life-threatening conditions.

This minimally invasive approach -- known as the Expanded Endonasal Approach (EEA) -- was pioneered and refined in adults over the last decade by surgeons at UPMC and the University of Pittsburgh School of Medicine and is now a viable option for tumors in children and in many instances for tumors that were once deemed to be inoperable.

Collaborating with colleagues at Children's Hospital of Pittsburgh of UPMC, surgeons have recently expanded its use to include children and have performed EEA on more than 50 pediatric patients, more than have been reported by any other center in the world.

In a retrospective study of the first 25 pediatric patients -- ranging in age from 3 to 18 -- who underwent EEA between January 1999 and August 2005 at Children's and UPMC, the surgeons found the approach may be safer than conventional surgical techniques in well-selected cases. More importantly, in certain cases it may offer an option to patients who otherwise would have no surgical alternative.

The traditional approach for removing benign or malignant tumors at the skull base has involved craniofacial approaches that require peeling away skin and soft tissue, as well as musculature over the facial elements. Often, this approach can be cosmetically disfiguring but may also involve the consequences of manipulating important neural tissue such as the optic nerve and the carotid artery. These issues are even more important in children because disrupting their facial plates, where their growth centers are, may have long-term implications. EEA involves using narrow scopes and surgical tools -- often developed by the surgeons themselves -- inserted through the nasal passage to remove tumors as large as baseballs.

"This review of our first 25 pediatric cases is very encouraging in that we were able to remove the tumor in each and every case with minimal complications," said lead author Amin Kassam, MD, associate professor and interim chair, Department of Neurological Surgery at the University of Pittsburgh School of Medicine and UPMC. "Minimally invasive endonasal surgery has many potential benefits over traditional surgery. Using these techniques we've developed, we are able to remove very large tumors without incisions and often with less risk of causing brain or nerve tissue damage as we are taking a more direct route to the tumor. Therefore, recovery may be faster with a shorter hospital stay."

Removal of the tumor was achieved in all patients in the study, and none suffered neurological damage, vascular injury or central nervous system infection, according to Dr. Kassam.