Dr. Jho's Endoscopic Brain and Cranial Surgery

Hae Dong Jho, M.D., Ph.D.

Facts About This Surgery

Offers minimally invasive alternatives for treatment of brain tumors, cerebrospinal fluid leaks (CSF), ventricular cysts and tumors, hydrocephalus, and cranial nerve disorders

Is minimally invasive because it often avoids the need for large incisions and excessive bone removal

Is innovative because it utilizes endoscopic technology which has been used repeatedly by Dr. Jho for pituitary tumor removal and for skull base tumor removal

Often assists in avoiding prolonged hospital stays

Utilizing an endoscope provides the surgeon with increased visualization of pathology facilitating less invasive treatment

Discussion

Through the endoscopic treatment for pituitary tumors and skull base (cranial base) tumors, numerous minimally invasive surgical procedures have been developed for the treatment of various other brain and cranial problems. Besides for pituitary and cranial base tumors, an endoscope has been applied to the repair of cerebrospinal fluid (CSF) leak. Patients that experience CSF leak, often called cerebrospinal rhinorrhea, exhibit drainage of clear colorless CSF fluid through one or both nostrils or experience postpharyngeal drainage (down the back of the throat). Whether of a spontaneous nature, or brought about traumatically, CSF leak can be corrected through the use of an endoscope, often placed through the nostril, and repaired surgically, most often by placement of an abdominal fat graft or titanium mesh. Tumors or cysts of the ventricles of the brain can be treated endoscopically for removal or fenestration. The ventricles of the brain are a system of intercommunicating cavities that are filled with CSF. Any pathology or disruption in this system can often lead to hydrocephalus, which is an excessive accumulation of CSF, often called "water on the brain". Hydrocephalus can also be treated endoscopically by performing ventriculostomy, or by placement of drainage catheters and other surgical techniques. Endoscopes can also be used in the treatment of cranial nerve disorders such as trigeminal neuralgia, when used in conjunction with open surgical treatment like retromastoid craniectomy for microvascular decompression.

Definitions

ventriculostomy - establishment of an opening or shunt between a cerebral ventricle and another cavity or to the exterior

IMAGES

Endoscopic Third Ventriculostomy

            

Obstructive hydrocephalus caused by a pineal tumor is treated with endoscopic third ventriculostomy.

Endoscopic Fenestration of an Arachnoid Cyst

            

A large arachnoid cyst was causing compression and shifting of the brain in this patient. The patient experienced right sided weakness and headaches (left). A postoperative MR scan shows resolution of the brain shift (right). The patient's right sided weakness recovered to normal .

An intraoperative endoscopic view shows a small slit which acts as a ball-valve and traps cerebrospinal fluid in the cyst cavity.

The cyst wall is endoscopically fenestrated widely to the subarachnoid space and cistern.

Endoscopic Removal of a Third Ventricle Tumor

            

MRI scans, coronal and sagittal views, demonstrate a third ventricle tumor and obstructive hydrocephalus.

            

The epidermoid tumor was excised endoscopically. Postoperative MRI scans reveal complete removal of the tumor in the third ventricle. The remaining tumor in the posterior fossa was operated on again endoscopically through a retromastoid approach six weeks later.

Endoscopic view of the third ventricle when it was visualized via a retromastoid posterior fossa approach.