Surgical Method for Brain Tumor Removal Essay

The brain is the most complex organ in the human body and it is the main command center for the nervous system (Peters, 2000). Advances in in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decade. There are various categories of procedures used to repair physical abnormalities or structural problems in the brain. Each procedure practiced regarding to the underlying abnormality being treated and the area of brain which damage has occurred. Brain surgery is complicated and required a critical clinical decision of the suitable surgical intervention based on various factors. Such as patient age, condition, tumor location and size. In this paper, I will critically analyze a comparison between craniotomy and trans-sphenoidal brain surgical interventions. In addition, it explores the main advantages of both approaches in order to conclude the best surgical method for brain tumor removal.

For instance, some of the brain abnormalities that could require a surgical intervention includes: neuro diseases, injury, birth defects or other problems such as brain tumor, skull fracture, and blood clots. Brain surgery has expected risks more than any other types of surgical interventions which are include stroke, impaired vision and speech, brain swelling, infection, bleeding, coma, memory problems, and imbalance. Depends on the underlying illness, the surgeon will determine which types of surgery will be implemented.  Some types of surgical methods such as craniotomy, biopsy, endonasal endoscopy, or neuro-endoscopy. 

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Currently, craniotomy is the most common performed surgical procedure. It removes a piece of the skull by uses special tools called bone flap and this tool allows the surgeon to access to the brain. The bone flap is covered or replaced with tiny plates and screws. Craniotomy size can be small or large depending on the health issue. This procedure requires a significant amount of brain re-traction which can result in contusion, edema, or venous compromise. After few weeks to months the patient can have follow up surgery called cranioplasty which replace the missing piece of skull with the original bone, and metal plate. Surgeons apply MRI or CT scans to guide to the exact place in the brain that wanted to be treated. There are some complications related to craniotomy including stroke, seizures, swelling of the brain, cerebrospinal fluid (CSF) leak, loss of some mental function, and nerve damage. It is noted that in the literature that 54.8% of craniotomy surgery patients have diabetes insipidus as complication of this procedure. 

Furthermore, cranial nerve injury is higher rate among patient who goes under craniotomy.

On the other hand, trans-sphenoidal is endoscopic surgery performed by insertion of tiny endoscope camera and light thorough the nose to remove tumor from the pituitary gland and skull base. Trans-sphenoidal approach provides an access to infrachiasmatic, olfactory, and subfrontal regions; and via transclival extensions, to the prepontine and perimesencephalic regions. The direct access to the skull in this method reduces brain retraction, and manipulation of neurovascular structures. Simultaneously, it offers a wide operative field in comparison to the standard craniotomy approach. 

The goal of trans-sphenoidal is to remove tumor safely. Most pituitary tumor is removed by working through one nostril and make a hole in the back of the nose into the bottom of the skull, consequently, the surgeon can see the tumor and pituitary gland through the hole. Due to the cavity that created by tumor removal the surgeon will remove a small piece of fat below the skin of abdomen and fill the cavity to avoid CSF leakage. Above than 60% of patients can be discharge to home after the first day post procedure. As a result of reconstructed of skull, the surgeons will use an absorbable man-med mash. In some cases, cerebrospinal fluid (CSF) could leak from the nose because of the fat or muscle are not hold and that will lead to infection of CSF which called meningitis. In the majority of cases, trans-sphenoidal tumor removal intervention, is effective and safe.

However, the evidence shows that, damage in pituitary gland is the main common complication and after the surgery the patient may need to take hormone replacement pills including thyroid hormone, growth hormone, cortisol, testosterone or estrogen. It is reported that 27.7% of trans-sphenoidal patients have diabetes insipidus as complication of the procedure. (Jeswani S, et al.Diabetes ) insipidus can occur in these cases as a result of the damage of posterior or back portion of the pituitary gland. 

Although both approaches have their advantages and disadvantages, there is no clear evidence whether one is superior to the other. However, this paper argues that trans-sphenoidal surgery is preferred procedure than craniotomy method. Trans-sphenoidal has less complications comparing to craniotomy. It offers the advantages of low morbidity and mortality, more less trauma to the frontal lobes and optic chiasm, less blood loss and no external scar (Tumul et al,2014). Another evidence of complete data mentioned that 53 surgeries 34 of them were treated with craniotomy and 19 with endoscopic endonasal transsphenoidal surgery (EETS), an increase rate of cranial nerve injury was noted on the craniotomy group. However, the progression-free survival curve and recurrence rate were similar in tow groups (Jeswani et al ,2015).

In conclusion, brain tumor surgery represents a unique challenge for neurosurgeons. To repair physical abnormalities in the brain, different surgical interventions are used. Both trans-sphenoidal and craniotomy can successfully remove brain tumor. According to the above mentioned evidence, selection of surgical intervention is based on the characteristics and location of the tumor. However, trans-sphenoidal is preferred surgical intervention because it has less complication and less neurological health issues. In addition, according to the long-term consequences of neurological surgical interventions, trans-sphenoidal has relative less negative outcomes in related to CSF leakage and nerve injury.



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