When we see “brain surgeons” operate on TV and in movies, they dramatically open the skull and delve deep into the brain tissue. In reality, it’s never that simple.
The brain is a complex and delicate organ, and some parts of it are difficult or impractical to reach safely by opening the skull.
Thankfully, there are other options for these hard-to-reach areas. Dr. Marc Otten, Director of Neurosurgery at NewYork-Presbyterian/Lawrence Hospital, recently gave a talk on one of those options—the transnasal approach—at the 10th Annual Otolaryngology Update in New York City.
The transnasal approach is just what it sounds like: The surgeon operates not by opening the back of the skull, but by going in through the patient’s nose.
He does this by using small, flexible tubes through which he can pass cameras and instruments. This type of surgery is called endoscopic or minimally invasive surgery, and it is one of Dr. Otten’s areas of specialization.
When would a surgeon need to use this technique? Dr. Otten covered one scenario in which this approach is useful—when a surgeon needs to reach part of the brain called the sellar region. The sellar region lies behind the bridge of the nose and below the base of the brain, close to the optic nerves. It’s an area that is difficult to access by opening the outside of the skull.
The sellar region houses the tiny pituitary gland, which is responsible for making important hormones the body needs to function well. Occasionally the pituitary gland can develop a tumor large enough to push out of the sellar region and press on the optic nerves and other areas of the brain. When this happens, it needs to be removed.
In addition to pituitary tumors, Dr. Otten talked about how the transnasal approach is best for other tumors in the sellar region, such as meningiomas, craniopharyngiomas and chordomas, which are rare tumors that can occur at the base of the skull.
So although it might seem strange to think of a surgeon operating on your brain through your nose, sometimes it is the best and safest option.
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