A new procedure allows neurosurgeons at Barnes-Jewish Hospital to remove tumors not through a major incision, but less invasively through a patient’s nose. The endonasal skull-based procedures allow patients diagnosed with some neurologic tumors fewer complications and a quicker recovery.
Traditionally, many skull based tumors were removed through a sublabial incision underneath the lip from incisor to incisor. While effective, many patients experienced numbness of upper gums and teeth, suffered issues with eating and drinking after surgery and initially would have significant discomfort.
The procedure has evolved to where Greg Zipfel, MD, Washington University neurosurgeon and his colleagues now remove the tumors completely endoscopically with a small endoscope and instruments, inserted through the nostril.
“Patients go home three days after surgery with no pain and only are taking Tylenol,” says Zipfel. “They’re getting back to work within days where in the past it would have been weeks.”
The procedure is primarily used to remove pituitary tumors. According to autopsy reports and radiologic and MRI evidence from around the globe it is thought one out of every five people worldwide has a pituitary tumor.
For those who have tumors removed in this less invasive fashion, they don’t even have their nose packed in recovery. “That’s the most common question a patient has,” says Ravi Uppaluri, Washington University otolaryngologist. “They may have sense of nasal congestion or a cold but that’s it.”
In the past few months, the procedure has moved to treating tumors deeper in the skull base. Some patients who in the past would have faced an open craniotomy with an open incision in the skull, now are treated with the endonasal approach, offering days of recovery rather than weeks. Dr. Zipfel sees more tumors being removed this way as technologies evolve, avoiding open surgeries and some of the complications that go along with that.