Keyhole Surgery: A revolution in malignant and benign tumors

Keyhole surgery is the concept of safely removing brain & skull base tumors through smaller, more precise openings that minimize collateral damage to the surrounding scalp, brain, blood vessels and nerves. Fortunately, given advances over the last two decades in technology and instrumentation, as well as improved brain and skull base anatomical understanding, a majority of brain and skull base tumors can now be removed through this surgical approach (Keyhole). Common keyhole craniotomies include the endonasal route (through a nostril), the supra-orbital route (through an eyebrow incision), the retro-sigmoid route (through an incision behind the ear) and the navigation-guided keyhole craniotomy for removal of deeply situated brain tumors. Dr. Mazda K. Turel, renowned Neurosurgeon, Wockhardt Hospital, Mumbai Central, talks about the advantages of Keyhole Surgery.

Notably, this approach is technically demanding, requires specialized instrumentation, significant surgical expertise and is not appropriate for all tumours. Consequently, there remains a role for conventional larger craniotomies.

Neurosurgeons are able to make a small opening in the skull, see the brain, using thin tubes fitted with a miniature camera (endoscope), and reach the tumour with the aid of finer instruments. Often this is done via the nose (nostrils), called endonasal endoscopy, but in some cases other minimally invasive brain surgery approaches may be more appropriate, such as the eyebrow approach (supraorbital craniotomy), from behind the ear (retromastoid crainiotomy) or other keyhole craniotomy approaches such as gravity-assisted surgeries.

The ideal surgical approach for each patient is determined by the specific tumour type and location. Regardless of the route chosen, a surgical team’s goals are to maximise tumour removal and minimise manipulation of critical structures, thereby avoiding complications and patient disfigurement, while promoting more rapid, complete and less painful recovery.

In particular, patients with pituitary tumour or tumours in the surrounding area, which sometimes cause problems with vision and eye movement, benefit from these newer ways of tumour removal.

Benefits of "keyhole" brain surgery:

Less pain than an Open Craniotomy

Faster recovery than an Open Craniotomy

Minimal scarring

Fewer complications and disfigurement

Less collateral damage (to surrounding tissues)

Lower risk of infection

Certain brain tumours still require a large bony opening for safe and effective removal. Additionally, some tumours that could be removed by a “keyhole approach” can also be removed by a traditional approach with an excellent outcome. Thus it is important that the Neurosurgeon performing a craniotomy for tumour removal selects the best approach based upon his/her own judgment and clinical experience.

For Appointment: Dr. Mazda K. Turel, renowned Neurosurgeon, Wockhardt Hospital, Mumbai