· Cushing's Disease
· Non-Functioning Tumors
"Keyhole approach" for microvascular nerve compression syndromes
Fully Endoscopic Removal of Acoustic Neuromas
Minimally Invasive, Tailored Meningioma Surgery
Minimally Invasive Endoscopic Craniopharyngioma Surgery
Head & Neck Tumors
· Orbital Tumors
· Paranasal Sinus Tumors
Managing Complex Facial Disorders
Endoscopic Skull Base Surgery through the Nostril
Fully Endoscopic Resection of Intracranial Symptomatic Arachnoid Cysts
· Apert's Syndrome
More Complete Resection of Chordomas with Endoscopic Techniques
Revolutionary Endoscopic Cerebral Aneurysm Clipping
Endoscope assisted microsurgery
Endoscopic Brain Surgery
A breakdown of what you need to know.
Dr. Hrayr Shahinian
A medical pioneer in performing skull base surgery.
"Keyhole approach" for complete excision of Pineal Tumors
Neuralgia: A Minimally Invasive, Endoscopic "Keyhole
Approach" for Neurovascular Compression Syndromes
The endoscopic approach is being performed at the Skull Base
Institute to surgically treat trigeminal
neuralgia, utilizing the most highly advanced and
minimally invasive techniques available. Trigeminal Neuralgia
is universally acknowledged as the most painful affliction
known to adult men and women and affects thousands of Americans
each year. The episodes of intense, stabbing, electric shock-like
facial pain are caused when a blood vessel comes in contact
with the fifth cranial (trigeminal) nerve, applying pressure
to the nerve. Patients with neurovascular problems such as
trigeminal neuralgia, hemifacial spasm, intractable vertigo
and spasmodic torticollis benefit tremendously from the Skull
Base Institute's innovative endoscopic "keyhole"
approach to these disorders and spend less down time, with
At the Skull Base Institute, Hrayr Shahinian, M.D., performs this delicate
microvascular decompression procedure through a dime-size
keyhole opening behind the ear. Through this opening, he inserts
a 2.7 mm endoscope. Dr. Hrayr K. Shahinian can then identify the problem
and perform the surgery - meticulously separating the nerve
and blood vessel, and inserting a Teflon disk between them.
Once the pressure has been relieved, patients usually report
immediate and complete relief from the pain. In many cases,
"keyhole" surgery for trigeminal neuralgia
is the preferred approach over traditional methods, in which
metal retractors and instruments are inserted through a much
larger opening behind the ear, and the brain is pushed aside
to reach the nerve compression area.
Since the introduction of the minimally
invasive, endoscopic “keyhole” approach,
numerous presentations have been made nationally and internationally
to both colleagues in the field and patients suffering from
neurovascular compression syndromes, such as Trigeminal Neuralgia.
Video tapes of the procedure have been requested by both the
National Trigeminal Neuralgia
Association and several of their regional support
groups. These videos can also be viewed on the Skull Base
Institute website in the dedicated Trigeminal
Neuralgia treatment section.
Tumor: Endoscopic Procedure Revolutionizes Pituitary Surgery
at the Skull Base Institute
One of the most extraordinary advances pioneered at the Skull
Base Institute is the minimally invasive, fully endoscopic
approach to treating pituitary
tumors and other skull base disorders. This innovative
procedure utilizes a tiny endoscope - 2.7 mm wide and 20 cm
long - with an angled tip that is inserted through the nostril
and into the skull base. This next-generation surgical approach
to treating pituitary tumors offers numerous advantages in
terms of decreased complications and recovery period.
First, because the camera is positioned at the tip of the
endoscope, Dr. Shahinian has a vivid panoramic view of the
brain. He can look around corners and make a full visual assessment.
This panoramic view also provides Dr. Hrayr Shahinian with the ability
to remove the entire pituitary tumor, in most cases. The process
is in sharp contrast to the traditional approach that requires
viewing the tumor site through a microscope outside of the
skull, which extensively limits visibility.
The point of entry for the Skull Base Institute’s minimally
invasive, fully endoscopic pituitary surgery is
through a nostril, so no incision is required. Consequently,
there is no scarring, no nasal packing, and the brain is undisturbed.
The time required for the actual surgical procedure, the length
of hospital stay and overall recovery time are dramatically
reduced. Patients return home within 24 hours of surgery,
and return to work and normal activities within a week. Since
invasive, endoscopic approach to pituitary tumors
started at the Skull Base Institute in 1994, numerous presentations
have been made nationally and internationally to both colleagues
and patients suffering from pituitary tumors. Articles, videos
and 3-D animations of the procedure have been requested by
the world-renowned Pituitary
Network Association, several of their regional
support groups and major media outlets such as CNN and the
Ellen DeGeneres Show.
This information can also be viewed on the Skull Base Institute
website in the dedicated Pituitary
Tumor treatment section.
CHAPTERS excerpt (click to category)
Surgery: The Evolution from Open Transcranial to Fully Endoscopic
Transnasal Surgery, and Beyond
By Mohamed S. Kabil, M.D. and Hrayr K. Shahinian, M.D.
Fully Endoscopic Pituitary Surgery
With the advent of modern endoscopic equipment, momentum in
the field of endoscopic pituitary surgery has stemmed from
studies, which show endoscopes provide more comprehensive
images of the pituitary gland and its surrounding structures
than does the operating microscope.38,52 This in turn should
allow for a more thorough tumor resection and fewer associated
The clinical implications of these findings have been reflected
in two separate studies of patients who underwent endoscope-assisted
microscopic resections of pituitary tumors.15,47,52,53 These
patients underwent a traditional microscopic transseptal-transsphenoidal
approach to their pituitary gland tumor. Then, following what
the surgeon believed to be complete tumor resection using
the microscope, endoscopes were introduced into the pituitary
region looking for residual tumor. In both series, an average
of 40% of patients were found to have tumor left behind that
was only discovered and resected during the endoscopic surveys.
In other words, the microscope alone allowed for complete
tumor removal in only 60% of patients.
to read the full Book Chapter
STUDIES excerpt (click to category)
Changing Face of Cushing's Syndrome: Mild and Periodic Cases
Makes the Diagnosis More Difficult
By Theodore C. Friedman, M.D., PhD, Erik Zuckerbraun M.D.,
Kimberly Daigle, Hrayr Shahinian, M.D., FACS
Additional Challenges of Cushing’s Syndrome
Many of the articles on Cushing's syndrome have examined patients
with sustained and severe hypercortisolemia. Because CBG limits
the amount of free cortisol (F) in circulation as F production
increases, many of the tests used to diagnose Cushing's syndrome,
such as UFC or night-time salivary cortisol may not detect
a mild increase in F production. Furthermore, the periodic
nature of Cushing's syndrome may lead to a normal measurement
of F status when a patient is tested during a quiescent phase.
Therefore, we determined the usefulness of several tests when
performed on multiple occasions in consecutive patients with
mild and/or periodic Cushing's syndrome.
We conclude that the great majority of patients presenting
to this tertiary Endocrinology clinic had periodic Cushing's
syndrome as evident by normal testing on 1 or more occasions.
Urinary 17-OHS was at least as sensitive as the more widely
used test, UFC. We conclude that there is no single test that
can always diagnose Cushing's syndrome and that the diagnosis
needs to be made by a careful history and physical coupled
with multiple tests assessing hypercortisolism.
to read the full Clinical Study
ARTICLES excerpt (click to category)
527 Fully Endoscopic Resections of Vestibular Schwannomas
By H. K. Shahinian , Y. Ra
Fully Endoscopic Acoustic Neuroma Surgery
We report a series of 527 patients with unilateral vestibular schwannomas (VS) who underwent fully endoscopic resection of their tumors during the period of October, 2001 to July, 2010. Patients ’ outcomes were evaluated, with specific regard to hearing preservation, facial nerve function, postoperative complications and completeness of the resection.
Utilizing the fully endoscopic technique, 94% of tumors were completely removed; subtotal removal was performed in 6% of patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients. Functionally, measurable hearing (serviceable / some) was preserved in 57% of cases that had either "serviceable" or "some" hearing pre-operatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, permanent lower cranial nerve deficits, or deaths.
to read the full Review Article
ARTICLES excerpt (click to category)
Vascular Decompression vs. Microvascular Decompression of
The Trigeminal Nerve
By Kabil M, Eby J, Shahinian HK
Fully Endoscopic Surgery for Trigeminal Neuralgia
From September 1999 till October 2004, 255 patients underwent
endoscopic vascular decompression of the trigeminal nerve.
These patients' records were retrospectively reviewed, and
additional data from follow-up visits was collected and analyzed
to ascertain success rates and review the incidence of complications.
From a total of 255 patients who underwent Endoscopic Vascular
Decompression (EVD) of the trigeminal nerve we noted an initial,
complete, postoperative success rate in 95% of patients. Initial,
being defined as within the first 3 months postoperative,
and "complete" being judged if the patient reported 98% relief
of pain postoperatively without the need for medication (Barker's
classification). Additionally, we documented a 93% complete
success rate for 118 patients who completed at least a three-year
follow-up period. Complication rates were compared to those
reported for MVD. There were no serious complications or mortality
in this series.
We conclude that EVD is a safe and effective method to remove
neuro-vascular conflicts related to the trigeminal nerve.
The results of this series demonstrate an improved rate of
trigeminal neuralgia relief with EVD when compared to MVD,
a lower incidence of complications and a better outcome.
to read the full Review Article