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New Approaches and Advanced Technologies in Neurosurgery

Neuroendoscopy

Endoscopy and endoscopic surgery have long been used as minimally invasive methods of viewing internal body structures and performing surgical operations without the need for large incisions. For example, a colonoscopy is a common endoscopic procedure that gastroenterologists use to screen for colon cancer and remove polyps. Endoscopic surgeries are associated with fewer risks of infection, reduced recovery time, and less blood loss than traditional open surgeries.

Now, Sheba Medical Center in Israel has made neuroendoscopy available to patients with brain pathologies. In neuroendoscopy, a fiber optic cable is inserted into the brain ventricles.

Dr. Jacob Zauberman explains, “This minimally-invasive approach is primarily used for surgeries in the cerebrospinal fluid cavities to treat hydrocephalus, to perform biopsies, and to remove cysts and small tumors. Surgeons can also use neuroendoscopy to remove tumors at the base of the brain and in the hypophysis, or pituitary gland.”

What Conditions can be Addressed with Neuroendoscopy?

The highly trained professionals in the Department of Neurosurgery at Sheba Medical Center regularly use neuroendoscopy in the treatment of aggressive or malignant brain tumors. These tumors are often gliomas, originating in the brain cells that encircle and support neurons. Such tumors include:

The following are additional kinds of brain tumors regularly treated at Sheba:

Craniopharyngioma

is a rare type of brain tumor and is typically very slow growing. While craniopharyngiomas are not aggressive, their treatment can be difficult, and significant morbidities are associated with both the tumor and the treatment. Our treatment team will usually surgically remove the tumor and follow that procedure with radiotherapy treatment.

Metastatic Brain Tumors

are caused by the spread of cancer cells from one or more tumor elsewhere in the body. Tumors that tend to spread to the brain include skin cancer (melanoma), breast cancer, and lung cancer. The treatment of these metastatic tumors includes surgical removal, radiosurgery, radiation, and chemotherapy.

Benign Brain Tumors

Benign brain tumors do not spread and typically do not endanger the patient’s life. However, even benign tumors can cause severe symptoms by causing pressure on the brain and/or spinal cord.

Meningioma

is typically a slow-growing tumor that arises from the meninges, the membranes surrounding the brain and spinal cord. Doctors often decide to treat meningiomas surgically to remove as much of the tumor as safely possible. The treatment team will use radiotherapy if there is a residual tumor or a recurrence after surgery.

Adenoma

is a benign tumor of the pituitary gland. Although adenomas are benign, these tumors have the potential to cause serious health complications by compressing other structures, like the optic chiasm, and by uncontrolled hormone production.

Acoustic Neurinoma

is another benign tumor. These tumors develop on the hearing and balance nerves near the inner ear. Surgical removal and radiotherapy are treatment options depending on the tumor stage at diagnosis.

Hemangioblastoma

originates in the cells of blood vessels. Although it is a benign tumor, hemangioblastoma growth usually results in a large cyst in the brain, but total tumor removal can result in complete resolution of the problem.

Colloid Cyst

is a benign cyst that develops in the anterior, or front, aspect of the third brain ventricle. Because of its location, a colloid cyst can cause obstructive hydrocephalus (cerebrospinal fluid buildup in the brain) and increased intracranial pressure. The expert surgeons at Sheba can now remove colloid cysts using minimally invasive neuroendoscopic surgery.

Pediatric Brain Tumors

differ from those in adults in terms of appearance, tumor types, treatment and response to treatment. The most common locations for tumors in children are the cerebellum, the pineal gland region, and the hypothalamus region near the optic nerves. Symptoms of pediatric brain tumors are often slow to appear and may be misleading.

Dermoids/Epidermoids

are slow-growing benign tumors made up of skin cells and skin follicles. Sometimes these abnormalities are found only in the skull, but they can also appear in central areas of the brain. Complete surgical removal of these structures leads to a comprehensive cure of the condition without the need for additional treatments.

The most common types of pediatric brain tumors are:

  • Medulloblastoma – representing about 20% of pediatric brain tumors
  • Pilocytic Astrocytoma – a benign glioma
  • Ependymoma – comprises about 10% of pediatric brain tumors
  • Germ cell tumors – usually treated with chemotherapy, but sometimes surgery is required

Normal Pressure Hydrocephalus

Additionally, the expert team at Sheba Medical Center is skilled and experienced in treating normal pressure hydrocephalus (NPH), a non-cancerous condition that usually develops in adults over the age of 60. NPH is characterized by the accumulation of excess cerebrospinal fluid in the ventricles of the brain. This accumulation may cause cognitive problems, difficulty walking, and loss of bladder control.

The success rate is about 90% in patients who respond well to a lumbar puncture, also known as a spinal tap. The rate of complications is small at less than 5%. Possible complications include infection, bleeding, or dysfunction of the shunt.

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