DIAGRAM illustrating how an endoscopic transphenoideal surgery is performed.

Published On:Monday, November 02, 2009

By JEFFARAH GIBSON

A REVOLUTION has been taking place these past few years in the field of brain surgery. It used to be accepted that persons in need of brain surgery had to face various serious complications, and in worst case scenarios even risks such as loss of vision and death; at best they had to deal with considerable pain and long recovery periods.

But due to the emergence of minimally invasive brain surgery, individuals experience less pain and recuperate much faster than when they undergo conventional open brain surgery. Not to mention, many of the serious risks are greatly reduced.

For years, doctors have been trying to find ways to reduce pain, scarring and long recovery periods after open brain surgery.

And as a result of advancements in technology, minimally invasive surgery has now proven itself to be both reliable and effective.

Endoscopy is a minimally invasive surgery that involves making small incisions under the skin to remove lesions from the brain, including tumours that can be as big as a softball.

This type of surgery is used to assess the interior of an organ by inserting a tube with a camera and a fibre optic light into the body.

Doctors get a close internal view of the brain as the camera projects the images on a large monitor, allowing surgeons to see every "nook and cranny" of the brain and leading to greater precision during the operation.

The operation leaves absolutely no room for errors, which is part of the reason its development took such a long time. Everything the doctor does must be precise and on point, any minor mistakes can cause severe damage to the brain.

Because of the level of training required to perform minimally invasive brain surgery, it is only available in a few countries around the world.

But Bahamians have relatively easy access to this highly developed form of surgery - they need only travel a short distance to Florida to have the operation done.

Dr Santiago Figuereo, MD, at the Miami Neurological Institute, is one of the few highly trained neurological surgeons in South Florida who performs this type of operation. He has 10 years of experience in this area, and has also performed the surgery on a number of Bahamians over the past few years.

He recommends endoscopy over traditional brain surgery for the removal of minor tumours, so that patients suffer less pain and are able to get back to living their lives as quickly as possible.

"Prior to the innovation of this endoscopic approach, a patient with a colloid cyst or pituitary tumour would have to undergo traditional brain surgery for the removal," he said.

He explained to Tribune Health the complex process of traditional brain surgery, touching on some of the complications that could result from the operation.

"Traditional brain surgery is complicated and requires that a large area of the skull be temporarily removed while the neurosurgeon cuts through the brain to get to the mass. There is a greater risk of complications, which includes seizures, memory deficits, stroke, bleeding, infections and others," he said.

With endoscopic brain surgery, not only are the risks much reduced, the operation time is a lot shorter.

"Depending on the location of the tumour, the operation can take as little as three hours to complete," Dr Figuereo said.

Patients will also spend a minimum of three to five days in the hospital and they tend to recover in a matter of weeks.

"I have had a lot of patients who've complained that they don't want to be away from work for such long periods of time, but with this surgery people can be up and running within a matter of weeks," he said.

For persons interested in this operation he recommends they do as much research as they can, and select a doctor who is an expert in the field because, as he says, "it is a safe procedure for only experienced hands."

Like all things, minimally invasive surgery has its disadvantages. As mentioned before, the level of training required is high, and not every surgeon can perform this operation. Also, currently the surgery is only used for the removal of relatively minor tumours, leaving the bigger problems to the decades-old approach of open brain surgery.

Even though this form of surgery represents one of the frontiers of modern medicine, conventional brain surgery is still widely practiced today, and there are some who prefer the tried and true way.