Endoscopic Innovation in Skull Base Tumor Removal | Cedars-Sinai

These procedures are not widely available because of the difficulty of developing the surgical skills and expertise.

“To get good at this approach, you have to do a lot of pituitary surgery to understand the basics really well,” Mamelak said. “Then you have to get comfortable with removing more and more bone and tissue, and working in a way that is sort of counterintuitive.”

Mamelak said the immediate hurdle to advancing innovation in minimally invasive surgical removal of skull base tumors is getting surgeons on board. Many times, Mamelak sees other surgeons opt for the craniotomy route they are more comfortable with—even when patients may be strong candidates for operating through the nose.

“It is difficult to convince surgeons to stop doing more traditional procedures and pursue a new, better option,” he said.

Over time, as data accumulates and surgeons build familiarity and skill with the procedure, he believes more surgeons will increasingly utilize the endoscopic procedure. At a minimum, he hopes to begin to see more surgeons refer patients who may be good candidates for endoscopic tumor removal for a consultation.

“If you have the expertise, the experience, the knowledge and the team put together, it’s tremendously revolutionary and can offer great benefits to patients,” Mamelak said.

For surgeons striving to become expert in the new method, the endoscopic endonasal approach can be practiced in an extremely lifelike environment. A video recently published in Operative Neurosurgery shows the utility of preoperative planning and surgical rehearsal in virtual reality. Surgeons can create three-dimensional renderings to examine the anatomy, then choose and rehearse the surgical approach. Rehearsal can improve surgical efficiency and has the potential to shorten the length of the surgery.