A new minimally invasive approach to brain surgery that targets complex tumours at the skull base has been hailed a game-changer.
Tumours arising in the base of the skull are among the most difficult to remove in neurosurgery.
The current treatment method is the microscopic anterior transpetrosal approach (ATPA), but this new endoscopic procedure is believed to result in shorter operative times and less blood loss.
A research team in Japan developed the minimally invasive surgical technique – a purely endoscopic subtemporal keyhole ATPA – to lessen the risk of damage and postoperative complications.
Dr Hiroki Morisako, a lecturer in the Graduate School of Medicine’s Department of Neurosurgery, and Professor Takeo Goto, who heads the department, led the Osaka Metropolitan University medical research team.
Writing in The Journal of Neurosurgery, they believe this is the first time this procedure to remove lesions in the petrous apex has been described in an article.
The endoscopic technique means a smaller area of the skull needs to be surgically opened compared to the microscopic approach, an average of only 11.2 cm² versus 33.9 cm². The risk of damage to the brain is also reduced.
The team performed 10 neurosurgeries using their method from 2022-2023 at Osaka Metropolitan University Hospital and compared the results to 13 surgeries using the microscopic ATPA from 2014 to 2021.
In terms of operative time, the endoscopic approach reduced it noticeably, from an average of 410.9 minutes to 252.9 minutes.
Similarly, blood loss lessened from a mean of 193 ml to 90 ml. The degree of tumour resection was just as high as the microscopic method.
At the same time, neurological functions were preserved at a rate equal to or higher than the conventional approach.
Professor Goto said: ‘Comparison of the new endoscopic method and the conventional microscopic method showed no significant difference in tumour resection rate or in the ability to perform daily activities before and after surgery, with the new endoscopic approach resulting in shorter operative times and less blood loss. The widespread use of this surgical procedure is expected to improve the treatment results of brain tumours in the base of the skull, not only in Japan but also worldwide.’
