Surgeons use specially designed instruments to remove otherwise inoperable,
baseball-sized tumors through the nose in children
PITTSBURGH, Feb. 8 /PRNewswire/ -- 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.
Other researchers involved in the study are: Ajith Thomas, MD, clinical
instructor, Department of Neurological Surgery, University of Pittsburgh
School of Medicine and fellow, Minimally Invasive endoNeurosurgery Center,
UPMC; Carl Snyderman, MD, professor, departments of Otolaryngology and
Neurological Surgery, University of Pittsburgh School of Medicine and co-
director, Endoscopic Neurosurgery/Skull Base Surgery Program, UPMC; Ricardo
Carrau, MD, professor, departments of Otolaryngology and Neurological
Surgery, University of Pittsburgh School of Medicine and faculty,
Endoscopic Neurosurgery/Skull Base Surgery Program, UPMC; Paul Gardner, MD,
resident, Department of Neurological Surgery, University of Pittsburgh
Medical Center and fellow, Endoscopic Neurosurgery/Skull Base Surgery,
UPMC; Arlan Mintz, MD, assistant professor, Department of Neurological
Surgery, University of Pittsburgh School of Medicine and director,
Endoscopic Neurosurgery/Skull Base Surgery Training Program, UPMC; Hilal
Kanann, MD, resident, Department of Neurological Surgery, University of
Pittsburgh School of Medicine; Michael Horowitz, MD, associate professor,
Department of Neurological Surgery, University of Pittsburgh School of
Medicine and director, Endovascular Neurosurgery, University of Pittsburgh
Medical Center; and Ian F. Pollack, MD, chief of the Division of Pediatric
Neurosurgery at Children's and professor of Neurological Surgery at the
University of Pittsburgh School of Medicine.
For more information about EEA, please visit http://minc.upmc.com. For
more information about Children's, please visit http://www.chp.edu.
SOURCE Children's Hospital of Pittsburgh of UPMC
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Related links:
http://www.chp.edu
http://minc.upmc.com
CONTACT:
Marc Lukasiak of Children's Hospital of
Pittsburgh of UPMC, +1-412-692-7919, or Marc.Lukasiak@chp.edu; or
Gloria Kreps of University of Pittsburgh Medical Center,
+1-412-647-3555, or Krepsga@upmc.edu
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