Department of  Neurosurgery
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Neuroendoscopy

Neuroendoscopy involves the use of an endoscope—a long flexible tube that has a video camera and a light source—to perform diagnostic or therapeutic procedures in the brain, spine, or peripheral nervous system. 

The endoscope can be equipped with specialized instruments to perform various procedures. Depending upon the location of a tumor(s), an endoscope can be maneuvered

  • through the nose (for diseases of the skull base)
  • through small incisions in the top of the head (for brain tumors or craniofacial conditions)
  • through small incisions in the back (for spinal disease)

Endoscopic Endonasal Skull-Base Surgery

Many diseases of the skull base can be treated with endoscopic endonasal skull-base surgery. Traditionally, the surgical approach for these diseases was through facial incisions or through an opening of the scalp and then removal of a piece of the skull. In endoscopic endonasal skull-base surgery, however, the surgical team advances an endoscope through the nasal cavity to view the anatomy and perform the surgery. The approach eliminates the need to make incisions in the scalp and/or face.

Washington University neurosurgeons and otolaryngologists team with other specialists to perform endoscopic endonasal procedures, which can be for the treatment of

  • Pituitary tumors
  • Chordomas
  • Chondrosarcomas
  • Craniopharyngiomas
  • Cysts
  • Meningiomas
  • Other types of brain tumors
  • Cerebrospinal fluid leaks

Pituitary Tumors

Please see Pituitary Tumors

Skull-Base Tumors

Chordomas and Chondrosarcomas - Chordomas and chondrosarcomas are rare, malignant tumors that typically arise in and around the clivus, a major bone of the skull base. Both tumors grow very slowly over a period of years and can be difficult to treat because of the location and extent of the tumors. Generally, the treatment of choice for chordomas and chondrosarcomas is surgical removal of as much of the tumor as possible, followed by radiation therapy. In the past, tumor removal required facial incisions and displacement of the facial bones. Adoption of the endoscopic endonasal approach has been a major step forward in the surgical treatment of these tumors and has resulted in improved patient outcomes. 

Meningiomas - Meningiomas are tumors that arise from the covering of the brain known as the dura or meninges. They typically are benign and may occur at the base of the skull. Previously, these tumors were removed through a craniotomy, or surgical removal of a portion of the skull. Some meningiomas now may be removed through an endoscopic endonasal approach, avoiding the side effects of a craniotomy including a prolonged recovery time.

Cerebrospinal Fluid Leaks - Cerebrospinal fluid (CSF) surrounds the brain and serves as a barrier and cushion. A person with a CSF leak is at risk for meningitis, a serious infection of the brain. CSF leaks can result from trauma or from other causes. CSF leaks can occur anywhere in the skull base. Traditionally, surgeons have made a large opening in the skull to visualize the site of the leak after lifting up the brain. Although this approach may still be appropriate for select cases, many CSF leaks can now be repaired using an endoscopic endonasal approach.  

Please also see Skull-Base Surgery

Intraventricular Neuroendoscopy

Colloid cysts - Neurosurgeons may use neuroendoscopy to remove colloid cysts, benign congenital tumors of the third ventricle that are rare and can cause headaches, vertigo, decreased memory, and behavioral changes.

Biopsy - Neuroendoscopy is used for biopsy of tumors in the ventricles of the brain.

Hydrocephalus - Endoscopic third ventriculostomies (ETVs) are used in the treatment of obstructive hydrocephalus. Obstructive hydrocephalus is a condition in which there is a build-up of cerebrospinal fluid (CSF) in the ventricles of the brain as a result of the blockage of CSF drainage. In ETV, the neurosurgeon makes a perforation in the floor of the third ventricle, allowing CSF to move out of the blocked ventricular system and into a neighboring CSF space. The goal of this procedure is to normalize pressure on the brain.

Faculty

Adult Neurosurgery Providers

Ralph G. Dacey, Jr., MD
Michael R. Chicoine, MD
Albert H. Kim, MD, PhD
Keith M. Rich, MD
Gregory J. Zipfel, MD

Pediatric Neurosurgery Providers

David M. Limbrick MD, PhD
Matthew D. Smyth, MD, FACS, FAAP

Otolaryngology Providers

Richard A. Chole, MD, PhD
Jonathan L. McJunkin, MD
Ravindra Uppaluri, MD, PhD
Bruce H. Haughey, MBChB, MS, FACS, FRACS