A minimally invasive approach to removing tumors in the brain offers no scars, a shorter hospital stay, and potentially fewer complications.

Surgeons at Rush University Medical Center (Chicago, IL, USA) used the transnasal technique, which has been very successful at removing pituitary tumors, to access the brain. The confluence of miniature surgical instruments, improved endoscopic visualization, computer-guided surgical navigation, and a membrane sealant has made it possible to safely access tumors beyond the dura, reducing the danger of cerebrospinal fluid leakage that could lead to serious complications, such as severe headaches, infection, and meningitis.

Guided by a computerized mapping system and an endoscope, surgeons drill small holes in a bone at the back of the nose and through the dura. With the camera images magnified on a screen, the surgeon can see exactly where he is threading tiny surgical instruments. The tumor is completely removed through the nostril. To complete the surgery, the hole in the dura must be completely sealed to prevent leaking of cerebrospinal fluid. The surgeons use material made from cadaver skin to create a tough scaffold. Several layers of the material along with fat harvested from the patient are placed over the hole; the material then expands to form a tight seal.

With an open surgery, we have to move the brain to gain access to the tumor. With the transnasal approach, it is amazing to see the brain beautifully undisturbed, said Dr. Richard Byrne, chairman of neurosurgery at Rush. We remove the tumor with the same borders as open surgery without manipulating the brain.

The transnasal approach is not appropriate for all brain tumors; it can be used for most skull base tumors, or tumors at the junction of the cranial skeleton and the nose or spine. The procedures require close cooperation between an experienced neurosurgeon and the head and neck surgeon.

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