Minimally Invasive Neurosurgery

Brain Great advances in minimally invasive neurosurgery have occurred recently, including endoscopic neurosurgery and Gamma Knife® radiosurgery. Cooper surgeons have been at the forefront, and are among the most experienced in the use of neuroendoscopy to treat some types of hydrocephalus, through a procedure called a third ventriculostomy. Dr. Turtz has been using neuroendoscopic techniques for many years and maintains the largest series of endoscopic treatment in the area. Other forms of intraventricular problems such as colloid cysts, arachnoid cysts and tumors may also be approached using neuroendoscopy. The Gamma Knife® represents the futuristic concept of “bloodless” brain surgery that maintains well over 30 years of documented clinical use. Cooper neurosurgeons are also proficient with the endoscopic techniques used in pituitary surgery.

In endoscopic brain surgery, a thin instrument (the endoscope) is used to navigate through the fluid-filled chambers of the brain. They can use endoscopic technology with image-guided surgical navigation techniques, using information from an MRI or CT done before surgery to help guide the operation. Neuroendoscopy is a minimally-invasive procedure and can be used as an alternative to a shunt, in select patients.

Gamma Knife® radiosurgery is a special type of radiation that focuses a high dose of radiation into the brain to destroy unhealthy brain tissue. It can be very effective for brain tumors and other abnormalities that can’t be treated with traditional neurosurgery, such as those that are in areas that are hard to reach surgically.

Gamma Knife® radiosurgery is virtually non-invasive, so no incisions are made. Most patients can go home the same day. Others need to stay in the hospital overnight.

To date, some 300,000 patients around the world have undergone Gamma Knife® surgery and each year more than 35,000 patients receive this treatment. When available, it is the patient’s preferred choice.

Gamma Knife® is used for treatment of vascular malformations, benign tumors, metastases and other malignant tumors, as well as functional disorders. Warren Goldman, M.D., PhD has pioneered Gamma Knife® radiosurgery in the area, having started two Philadelphia-based Gamma Knife® sites prior to joining Cooper University Hospital.

Minimally invasive neurosurgery isn’t the answer for all patients. Before any surgery, the Cooper surgeon will discuss the procedure with the patient in detail, including whether to use minimally invasive techniques or traditional surgical intervention, based on the best outcome, specific to the patient’s medical history.

Endoscopic Neurosurgery

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VIDEO > In this animated video, Dr. Alan Turtz explains the ETV procedure. Both 'before' and 'after' video clips of a patient are shown.

Endoscopic Ventriculostomy for Hydrocephalus
The standard treatment for obstructive hydrocephalus has been the implantation of ventricular peritoneal (VP) shunts to divert the flow of CSF. This method, though effective, is associated with many problems (e.g., blockage, infection). An alternative treatment, for some patients, called an endoscopic third ventriculostomy (ETV) is performed using a surgically-navigated endoscope to restore the flow of cerebrospinal fluid without the need for implants.

Endoscopic Resection of Pituitary Lesions
A pituitary tumor is an abnormal growth of cells on the pituitary gland. Some pituitary tumors produce hormones which change the patient’s hormonal balance; others do not. Endoscopy is one way of treating pituitary tumors. Cooper surgeons can use endoscopic techniques to remove (some) pituitary tumors.

Other Minimally Invasive Neurosurgery Procedures

Gamma Knife Stereotactic Radiosurgery
Gamma Knife® surgery has many advantages. The risk of complications, as compared to open surgery, is less and it is a gentler form of treatment for the patient. Unlike other radiation-related procedures, Gamma Knife® surgery is usually one event (not stretched out in stages) and can normally be performed in a day. The convalescence time is extremely short.

For more information about Gamma Knife radiosurgery, please click here to view a comprehensive overview.

Image-Guided Cranial Surgery
The latest technologies coupled with years of traditional surgical skill best describe the style of brain treatments offered now by Cooper’s neurosurgeons. A unique approach to certain deep brain tumors is through an eyebrow approach, a minimally-invasive technique called an Orbitofrontal Craniotomy, where not a hair is removed from a patient’s head.

Every neurosurgical procedure is approached with minimally-invasive technique in mind to reach the curative goal; enhance patient safety and improve outcomes.

Restorative Neurosurgery
Cooper has put together a team of highly-skilled professionals for the diagnosis, treatment and rehabilitation of patients with medically intractable pain, Parkinson's Disease and other disorders. Surgical treatments, namely Pallidotomies and Thalamotomies, have recently advanced, coupling high-definition imaging, image-guided stereotaxy and intraoperative monitoring. These techniques have turned these procedures into exciting tools for treatment of certain intractable movement and seizure disorders.

Depending upon the nature and severity of the disorder, taking factors such as age and other medical conditions into consideration, surgical intervention can range from non-invasive techniques, such as Gamma Knife® to minimally-invasive procedures using an ablative probe. The patient is usually awake for these procedures.

Stereotactic Surgery
Derived from the Greek, stereotaxis means “arrangement in space”. Stereotactic surgery is a method of locating structures inside the body using 3D coordinates, for surgical intervention such as ablation, biopsy, stimulation and implantation for treatment.

Using extremely precise instrumentation coupled with image-based planning and guidance, cranial tumor biopsies are performed here with speed and accuracy. Dr. Goldman and Dr. Turtz are pioneers in the use of this technique, done through a small incision, having performed thousands of stereotactic procedures since the early 1980’s.

Technology-Enhanced Spine Surgery
Cooper neurosurgeons use the latest surgical techniques along with enabling technologies for minimally invasive spine treatment , ranging from lumbar disc surgery through a small incision to image-guided pedicle screw placement in order to correct spine dysfunction or instability. Another interesting spine technique performed by Dr. Turtz and Dr. Yocom here at Cooper is Balloon Kyphoplasty.

Balloon kyphoplasty is a minimally invasive surgical solution for vertebral body compression fractures (VCFs) caused by osteoporosis. Using a small (one quarter inch) incision, a special needle is inserted into the fractured spinal bone. This needle delivers a “balloon” to the site. The balloon is inflated to lift the collapsed vertebrae to its original height and alignment. The balloon is then deflated and removed. A small tube is inserted into the site to allow for placement of the bone cement. The bone cement fills the cavity that was created after the balloon was withdrawn. The tube is then removed and a band-aid is placed over the incision site. Once the cement sets, it will retain the newly created height. Most patients will have a 70 to 90 percent reduction in pain within 48 hours of the balloon kyphoplasty.

Doctors Who Perform These Minimally Invasive Procedures

For more information or to schedule an appointment with a Cooper University Physician at an office near you, call 1-800-8-COOPER (800-826-6737).