Cedars-Sinai Blog

Seeing the Light: Neuroendoscopy Revolutionizes Skull Base Surgery

Neuroendoscopy for Skull Base Surgery: What Is It?

Cedars-Sinai co-director of the Pituitary Center and professor of Neurosurgery, Adam N. Mamelak, MD

Adam N. Mamelak, MD

When you hear the phrase endoscopic skull base surgery, you probably don't think of ancient Egypt. Maybe you should, says Dr. Adam N. Mamelak, co-director of the Pituitary Center and professor of Neurosurgery at Cedars-Sinai.

Thousands of years ago, the great civilization was the first to discover that you could access the brain through the nose, as they searched for a way to remove the brain while preserving the faces and skulls of deceased royalty.

Fast forward to the 21st century—endoscopic technology has revolutionized skull base surgery, which addresses a range of conditions, from pituitary tumors to other cancerous and non-cancerous growths, cysts and fistulas.

Part of the movement toward minimally invasive techniques, neuroendoscopic surgery makes a big difference for patients who have medical disorders of the skull base—a crowded and complex area with several openings through which blood vessels, nerves and the spinal cord all pass.

How does it work?

An endoscope is a slim tube that lights up the area in question and takes high-resolution images in real time. That way, the surgical team has an extremely precise, moment-to-moment view of what they're working on. Unlike traditional, open-skull surgery, which would involve a large incision in the face or skull, here the surgeon inserts instruments through the natural openings—the nose or mouth. The team is tailored to the patient's unique condition and may include ear, nose and throat specialists, maxillofacial surgeons, neurosurgeons and radiologists.

"This is one of the best things we do here at Cedars-Sinai: multidisciplinary approaches to complex problems"

Why does it matter?

Endoscopic surgery means less trauma as well as greater accuracy and precision. Patients can expect not only better results but a much easier and more comfortable process with quicker recovery times and shorter hospital stays. Because there's minimal trauma to the structures of the face and skull, there's also minimal cosmetic impact.

Dr. Mamelak uses the following analogy: "If you need to change your car's muffler, you could either open the hood, work around the engine block and then reach the carburetor to take it out, or you could just go under the car and remove it while avoiding other structures," he says. "Open skull surgery is like going in through the hood. Endoscopic surgery is like working from underneath the car."

What makes Cedars-Sinai different?

Cedars-Sinai was among the first to have a comprehensive pituitary center, and an integrated team that includes specialists such as endocrinologists, radiation oncologists and neurosurgeons to ensure optimal outcomes for every type of skull base condition.

"For our patients, the experience becomes so straightforward and easy," explains Dr. Mamelak, adding that patients benefit from decision-making and a quality of care he describes as hard to find. "This is one of the best things we do here at Cedars-Sinai: multidisciplinary approaches to complex problems."