An alternative to craniotomy


Brain surgery is a big deal, requiring a complex navigation of the organ that is the center of the nervous system.

But Emory neurosurgeons have found a new approach to brain surgery that is less intimidating. They now are able to remove benign tumors from deep within the brain through openings in the skull no bigger than a pea.

The new endoscopic treatment is less risky, takes less time, and necessitates a shorter hospital stay than standard surgery. In Georgia, it is available only at Emory University Hospital Midtown.

The most common brain tumors removed by this method are colloid cysts, which can cause an increased buildup of cerebrospinal fluid CSF in the the brain. They account for approximately 1% of all intracranial tumors. Blockage of the normal flow of CSF can lead to increased intracranial pressure—resulting in headache, vertigo, memory impairment, limb weakness, and behavioral changes. The tumors can even cause sudden death.

In most medical centers, surgeons perform a craniotomy to remove colloid cysts. The craniotomy involves a large incision and complete opening of the skull. By contrast, Emory neurosurgeon Costas Hadjipanayis removes these tumors through small incisions and openings in the skull through which he threads a 6-mm endoscope fitted with a fiberoptic camera. After identifying the location of the cyst using the endoscope, surgeons then pass 2-mm instruments through small openings to remove the tumor. They also are able to create new pathways to drain CSF so that no shunts for excess drainage are needed.

The endoscopic approach to brain surgery is one of many medical advances pioneered at Emory. Others featured on a new webpage ( include endoscopic heart surgery that allows surgeons to perform coronary artery bypass without opening the chest cavity and stopping the heart, a nutritional treatment for cancer that uses soy products to release cancer-fighting genes that have been silenced, and an alternative technique for hip replacement that minimizes removal of muscle from the bone and preserves hip stability.

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