Mr Bassel Zebian, a consultant neurosurgeon at King’s College Hospital, has adapted an endoscopic ultrasonic aspirator – a device that uses ultrasonic vibration to fragment a brain tumour and remove it – in order to carry out minimally invasive neurosurgery for deep tumours that would otherwise be extremely difficult to access.
The technique Mr Zebian uses in selected patients is the equivalent of keyhole surgery in the brain. The procedure is performed through a neuroendoscope – a small metal tube with a camera at the tip and a channel to allow instruments to pass through.
In some cases a hole about 9mm wide is made in the skull for the endoscope to be inserted. Mr Zebian was able to modify an endoscopic ultrasonic aspirator to fit through a specific endoscope. This allows him to navigate the ventricles of the brain and reach very deep lesions and remove them with minimal damage to the surrounding healthy brain. The alternative technique would have resulted in a much bigger corridor, a few centimetres in diameter, through the healthy brain to allow access to the deep tumour.
Mr Zebian said: “This technique minimises damage to the healthy brain whilst maximising visualisation of and access to deep tumours. The difficulty neuroendoscopic surgeons often face is the control of bleeding and the lack of adequate instrumentation. With our modification of existing instruments we have been able to push the limits of minimally invasive resections in the best interest of our patients and we are increasingly able to resect even large, deep, solid tumours with one of the biggest cases series in the world.”