New Endoscopic Neurosurgery Approach Targets Difficult Tumors at Skull Base

Tumors at the base of the skull represent some of the most challenging cases for neurosurgical removal. The present method for their extraction has been through the microscopic anterior transpetrosal approach (ATPA). Now, in new research published in The Journal of Neurosurgery, a medical research team has taken a new approach to lessen the risk of damage and postoperative complications, as the skull base is densely packed with nerves, blood vessels, and other tissues, not to mention the brain stem.

Researchers at Osaka Metropolitan University (Osaka, Japan) have developed a less invasive surgical method termed as a purely endoscopic subtemporal keyhole ATPA. This technique, reportedly the first of its kind to be described article, targets lesions at the petrous apex of the skull base. By employing an endoscopic approach, the required surgical opening is substantially smaller—only 11.2 cm² compared to 33.9 cm² with the microscopic method, significantly lowering the potential for brain damage.

From 2022 to 2023, the team conducted 10 surgeries using this new method and evaluated these against 13 previous surgeries performed using the microscopic ATPA from 2014 to 2021. The endoscopic technique notably reduced the average operative time from 410.9 minutes to 252.9 minutes and decreased blood loss from an average of 193 ml to 90 ml. Importantly, the extent of tumor removal achieved was as high as that of the microscopic technique, and the preservation of neurological functions was equally good as, if not better than, the traditional approach.

“Comparison of the new endoscopic method and the conventional microscopic method showed no significant difference in tumor 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,” said Professor Takeo Goto, who heads the Graduate School of Medicine’s Department of Neurosurgery and led the team. “The widespread use of this surgical procedure is expected to improve the treatment results of brain tumors in the base of the skull, not only in Japan but also worldwide.”

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Osaka Metropolitan University