Skull-based Surgery to Remove Brain Tumors
of the skull-based surgeries at Crouse Neuroscience Institute.”
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Is there pain for the patient when you do these surgeries? “With the minimally invasive procedure, we’re able to do it through the sinuses. Every surgery has pain, but it’s often controlled with a little bit of Tylenol. Because we do this so often we’re able to make the incisions smaller and smaller over time and take out less and less of the skull to get to where we need to go because we’re so familiar with those areas.”
8 Questions to Eric Deshaies, M.D. By Matthew Liptak
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hysicians Eric Deshaies, Parul Goyal and Brian Nicholas do approximately three skull-based surgeries a week through the Crouse Neuroscience Institute. Minimally-invasive skull-based surgery addresses a variety of tumors that can be found deep in difficult-to-access areas of the brain near the eyes and nose. The procedure replaces time-consuming surgeries. Patients may be able to go home a day after the surgery.
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Why is this skull surgery such an advancement? “The skull-based surgery in and of itself is not too much of an advancement. Traditionally it’s a difficult neurosurgery where often we need to take people’s faces apart or [go to] deep areas of the skull to get to these tumors. But now with minimally-invasive techniques we have used tiny little scopes to get to these deep areas of the skull and the bottom of the brain. It’s extremely delicate because at the bottom of the brain lie some critical structures called the brain stem, which is just above the spinal cord. In this area lies the seat of the breathing center and the heart center and the area for being awake and not being in a coma. We work with a
team of ear, nose and throat specialists as well as specialists in surgery of the eye and plastic surgery.
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Has it decreased surgical time? “It significantly decreases surgical time to probably 10 percent [of what it was]. We’re able to take these tumors out through the nose in adults and children. Traditionally, the patient will be in the hospital a week or more with hours of surgery. [Now] we’re able to get them done in one to two hours and the patient goes home in the next day.
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Might it have applications for other types of surgery down the road to access the skull through the nose? “Yeah, there are other surgeries that can potentially be done, but it needs more work, where we can treat brain aneurisms this way and some other complex tumors in the minimally invasive way. But again it hasn’t been perfected yet.”
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What kind of tumors can be operated on this way? “Pituitary tumors, any tumors of the base of the front of the skull. That includes the sinuses and part of the brain, people with spinal fluid leaks; people with tumors called Rathke’s cleft cyst, the meningiomas, benign tumors as well as some malignant tumors in this region — anything that essentially goes deep to where the nose and the eyes lie we can reach. It doesn’t matter what type of tumor it is, it all has to do with the location.
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Is Crouse the only hospital that does this? “It really doesn’t have to do with the hospital. It has to do with the surgeons. There’s myself and Dr. Parul Goyal and Dr. Brian Nicholas. We’re the ones who do a lot
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Is the minimally invasive surgery through the nose less risky than the invasive surgery? “If you don’t know what you’re doing, you’d be at much more risk because you’re going through a very tiny hole rather than a much bigger exposure.”
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How many of these minimally invasive surgeries have you done? “We do a few a week. We do them very often. Over time I’ve been able to see this field evolve from doing maximum invasive procedures in neurosurgery to one of the least invasive. The least invasive surgery we’ve been doing for probably about five years. With Dr. Goyal’s expertise — he’s one of the only fellowship-trained surgeons with the endoscope in the region — and having both of us here with expertise, [it] has allowed us to hone in.
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • December 2016