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Fall 2006

Innovative Surgery Removes Certain Brain Tumors

UCLA has one of the largest patient experiences in the world removing tumors through a nostril

In a new twist to brain surgery, UCLA neurosurgeons are removing certain brain tumors through a patient's nostril, allowing for an easier and more rapid recovery, notes Daniel Kelly, M.D., UCLA neurosurgeon and director of the UCLA Pituitary Tumor and Neuroendocrine Program. Well-suited for this approach are small benign tumors-known as meningiomas- that sit above the pituitary gland and typically cause loss of vision.

"UCLA has one of the largest patient experiences in the world with the extended direct endonasal transsphenoidal approach, which removes brain tumors through a nostril with an operating microscope and endoscope," says Dr.  Kelly. Traditionally, these tumors were removed through the skull (craniotomy), and more recently by going under the lip (the sublabial transsphenoidal approach). "The approach through the nostril provides a less invasive and more direct trajectory to the tumor than either a craniotomy or the sublabial approach, and requires no incisions," Dr. Kelly points out.

Meningiomas are the most common benign brain tumor removed this way. These tumors occur more frequently in women than men, usually arise during ages 30 to 70 years, and can occur in the spine or brain, although most commonly the latter.

"Meningiomas are usually attached to the dura-the outer covering (meninges) of the brain-so they are not in the brain but are pushing against it, causing such symptoms as visual loss, seizures, weakness and headaches," Dr. Kelly explains. Meningiomas are typically best diagnosed with magnetic resonance imaging. Meningiomas best suited for endonasal removal push on the optic nerves, usually causing visual loss in one or both eyes. Overall, with the approach, the visual improvement rate averages 80 percent.

UCLA neurosurgeons have performed more than 700 of these endonasal surgeries, including over 80 such surgeries to remove brain tumors. Read more at www.pituitary.ucla.edu 





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