Dr. Costas G. Hadjipanayis
Specialties: neuro-endoscopy, awake craniotomy, cortical/subcortical mapping techniques

Minimally Invasive Neurosurgery at Emory Crawford Long Hospital

Emory University neurosurgeon performing minimally invasive neuro-endoscopic procedures at Emory Crawford Long Hospital for removal of brain and skull base tumors and treatment of hydrocephalus.

Neuro-endoscopy is a relatively new field in neurosurgery that has evolved and allowed for the safe treatment of deep seated tumors in the brain and skull base. A rigid fiberoptic lens with a working channel is used to visualize tumors within the ventricular system of the brain and permit excision or biopsy. Certain brain tumors such as colloid cysts are amenable to treatment by neuro-endoscopy. Colloid cysts are located in a delicate area of the brain and can be life-threatening as they grow. Traditional surgery requires a craniotomy (removal of portion of skull) and retraction of the brain for removal of colloid cysts. Patients who undergo endoscopic resection of these tumors undergo placement of a small incision on the scalp followed by a small opening in the skull (7 mm) to allow for insertion of the endoscope and its associated working channel sheath measuring 6 mm in maximal diameter. Very small (2 mm) endoscopic instruments are used to remove the colloid cyst in its entirety.

Neuro-endoscopy is also used for performing third ventriculostomies for relief of hydrocephalus without placement of a shunt. Certain patients who are candidates enjoy the benefit of not having a shunt which can malfunction or become infected and eventually require replacement. The procedure, known as an endoscopic third ventriculostomy (ETV) relies on the placement of a hole in the floor of the third ventricle to divert the fluid naturally produced by the brain, CSF, through a different pathway.

Skull base tumors such as meningiomas and clival chordomas can be removed by endoscopic assistance through the patient's nose. Placement of the endoscope through the natural orifice of the nare can permit visualization and access to the skull base for removal of deep-seated midline tumors avoiding any skin incision, removal of skull, or brain retraction. Endoscopic access to the skull base is achieved by a team approach between neurosurgeons and otorhinolaryngologists.

Dr. Costas G. Hadjipanayis, assistant professor in the Department of Neurological Surgery, is performing minimally-invasive neuro-endoscopic procedures at Emory Crawford Long Hospital. He is using neuro-endoscopy for the removal of colloid cysts, decreasing the length of hospitalization for patients and increasing patient satisfaction. He is using neuro-endoscopy to biopsy deep seated brain tumors that are amenable to treatment by other minimally invasive techniques such as stereotactic radiosurgery. In addition, he is performing ETVs for the relief of hydrocephalus avoiding the placement of a shunt in select patients.

With the assistance of Dr. Alpen Patel, assistant professor in the Department of otorhinolaryngology, Dr. Hadjipanayis is also removing certain skull base tumors endoscopically through the nose. Patients can have deep seated tumors removed without the need for a craniotomy and the potential morbidity from brain retraction.