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Endoscopic Innovation in Skull Base Tumor Removal Aug 27, 2021 Cedars-Sinai Staff Share Tweet Post To Adam Mamelak, MD, the traditional method of skull base tumor removal is "like trying to change the muffler at the bottom of your car by opening up the hood of the engine and going around the entire engine block." Rather than operating at the skull base via an invasive craniotomy, Mamelak and the expert neurosurgery team at Cedars-Sinai are leading the way on innovative methods to resect a skull base tumor from underneath the brain, using an endonasal approach and minimally invasive endoscopic methods. "This is going to revolutionize this area of skull base surgery for tumors that were traditionally always operated on through a craniotomy," Mamelak said. "The difficulty is, there’s a relatively small subset of surgeons that are experts at these procedures."
Adam N Mamelak MD Neurosurgery
Adam N Mamelak MD Neurosurgery Accepting New Patients In-person Visits 310-423-7900 Accepting New Patients Call to Schedule "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."
Innovations in skull base tumor removal The skull base is a complex area that sits at the interface between the face, brain and skull, and contains vital arteries and veins connecting the brain to the body.
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Kevin Wang 2 minutes ago
Tumors that affect this area include pituitary tumors, meningiomas, craniopharyngioma, chordomas and...
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Evelyn Zhang 3 minutes ago
Advanced endoscopic tools can maneuver and angle in many directions, providing a wider navigable fie...
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Oliver Taylor Member
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Thursday, 08 May 2025
Tumors that affect this area include pituitary tumors, meningiomas, craniopharyngioma, chordomas and chondrosarcomas. With the endoscopic approach, the surgeon enters through the nose, avoiding the need to open the skull, manipulate the brain and navigate around critical blood vessels and the sensitive optic structures. "As the technology and instruments have expanded, the surgeon can now go truly inside the brain from underneath it, rather than on top of it," Mamelak said.
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Madison Singh 2 minutes ago
Advanced endoscopic tools can maneuver and angle in many directions, providing a wider navigable fie...
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Brandon Kumar Member
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Advanced endoscopic tools can maneuver and angle in many directions, providing a wider navigable field of vision inside of the skull. The surgeon carefully removes bone and tissue at the base of the skull and behind the back of the nose to expose and ultimately resect the tumor. Otorhinolaryngologists (ear, nose and throat surgeons) work with the neurosurgeons as a team and play a primary role in gaining access to the skull base and repairing it after the tumor has been removed.
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Daniel Kumar 3 minutes ago
Read: Perspectives from a Brain Tumor Survivor
Advantages and promising research Transsphenoidal...
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Ava White 1 minutes ago
"There is no external swelling or bruising." Most importantly, he added, the techn...
Read: Perspectives from a Brain Tumor Survivor
Advantages and promising research Transsphenoidal endonasal endoscopic surgical procedures offer four advantages: improved field of vision for the surgeon; the ability to work below and easily see critical structures such as the optic nerves and carotid arteries rather than around them; avoiding the need for a craniotomy; and eliminating cosmetic impacts for the patient. "Cosmetically, it looks literally like no surgery was done," Mamelak said.
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Audrey Mueller Member
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"There is no external swelling or bruising." Most importantly, he added, the technique is effective. New data shows that for some skull base tumors, the endoscopic approach is associated with better patient outcomes.
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Hannah Kim 8 minutes ago
Due to the novel nature of the procedure, data is limited, with studies typically occurring at a sin...
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Ava White 8 minutes ago
The study found "no differences in rate of gross total resection or perioperative complicat...
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Lucas Martinez Moderator
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Due to the novel nature of the procedure, data is limited, with studies typically occurring at a single institution. A 2018 meta-analysis in Neurosurgery that included Cedars-Sinai analyzed the outcomes of tuberculum sellae meningioma resection, comparing the traditional transcranial approach to an endonasal endoscopic approach.
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Mia Anderson Member
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The study found "no differences in rate of gross total resection or perioperative complications between the two groups." The endonasal endoscopic group was associated with higher rates of cerebrospinal fluid leak, but increased postoperative visual improvement. Read: One Patient Finds a Brain Tumor Has Its Benefits
Techniques demand intense expertise These procedures are not widely available because of the difficulty of developing the surgical skills and expertise.
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Ava White 10 minutes ago
"To get good at this approach, you have to do a lot of pituitary surgery to understand the ...
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"It is difficult to convince surgeons to stop doing more traditional procedures and pursue ...
"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.
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Amelia Singh Moderator
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"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.
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Luna Park 7 minutes ago
"If you have the expertise, the experience, the knowledge and the team put together, it’s...
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Audrey Mueller 23 minutes ago
A video recently published in Operative Neurosurgery shows the utility of preoperative planning and ...
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Henry Schmidt Member
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"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.
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Sophie Martin 5 minutes ago
A video recently published in Operative Neurosurgery shows the utility of preoperative planning and ...
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William Brown Member
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Thursday, 08 May 2025
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.
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William Brown 22 minutes ago
Read: Differences Between a Stroke and a Seizure
What s next in surgical treatment for skull bas...
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Evelyn Zhang 37 minutes ago
Endoscopic Innovation in Skull Base Tumor Removal Cedars-Sinai Skip to content Close
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Read: Differences Between a Stroke and a Seizure
What s next in surgical treatment for skull base tumors Mamelak is excited for what’s next in endoscopic tumor surgery. In the future, he envisions an opportunity for flexible scopes and instruments and even robotic manipulations where a robotic tool can visualize or be used for dissection. Tags Brain Neurology Neurosurgery Share Tweet Post
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Brandon Kumar 40 minutes ago
Endoscopic Innovation in Skull Base Tumor Removal Cedars-Sinai Skip to content Close
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Elijah Patel 58 minutes ago
Tumors that affect this area include pituitary tumors, meningiomas, craniopharyngioma, chordomas and...