Surgeon Journeys to the Center of the Brain, Without the Craniotomy

	Dr. Souweidane, at the head of the table, removes a tumor with the endoscope.
	Dr. Souweidane, right, instructs a resident physician.One of the duties of doctors at academic medical centers such as Weill Cornell is teaching others their trade.

Neurosurgeon Dr. Mark Souweidane is using an endoscope, a pencil-sized shaped camera, to reach near the center of the brain and to remove intraventricular brain tumors in children. These tumors, which may be malignant or benign, can grow to frequently block the narrow pathways that allow fluid to circulate between the brain's ventricles and cause hydrocephalus, a dangerous condition where the brain swells against the skull.

Patients with hydrocephalus usually have a craniotomy: surgeons remove part of their skull in order to reach the brain and fix the problem. However, Dr. Souweidane may have found a better way. As an internationally known leader in the field of neuroendoscopy, Dr. Souweidane has been working with the endoscope for years and has refined the technique to where he now feels comfortable removing these deep brain tumors with it.

For patients, there are multiple benefits. The risk of creating a small hole in the skull is far less than removing a significant part of it; the recovery time is shorter; and the scarring (which can be significant with a craniotomy or traditional open surgery) is minimal with endoscopic surgery.

How the procedure works:

In the operating room, Dr. Souweidane creates a small 14 mm hole in the patient's skull for access and then guides the endoscope through the brain's fluid-filled compartments and toward the tumor site. Visually, the scene resembles swimming through a soft coral reef, where the coral (or, in this case, structures inside the brain's ventricles) parts to let the scope move through it. Dr. Souweidane watches the endoscope's image on a monitor and when the tumor is reached, the tools that will biopsy or resect the tumor are deployed through the endoscope's 2 mm "tunnel." (view diagram)

The endoscope

Surgeons can reach near the center of the brain without significant cutting of tissue or draining of intracranial fluid, which can cause the brain to "sag" away from the skull and bleed. Patients routinely leave the hospital the day after surgery.

About the doctor:

Dr. Mark Souweidane is vice chairman of the Department of Neurological Surgery, director of pediatric neurosurgery, an associate professor of neurological surgery, and an associate professor of neurological surgery in pediatrics at Weill Cornell Medical College. He is also an associate attending neurological surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.