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Minimally Invasive Procedures at the Forefront
Bloodless Surgery Donor directed transfusion in children for elective surgery remains a mainstay of therapy for most neurosurgical interventions. Based upon the need for blood products on the local and national levels, potential complications following transfusion and religious beliefs that prohibit transfusion, these considerations remain of significant importance. Children’s has now established a protocol to allow for bloodless surgery. This protocol includes the preoperative administration of epoetin to maximize the hematocrit in addition to the use of isovolemic or hypervolemic hemodilution to lower the patients’ hematocrit intraoperatively. The protocol recently allowed for the first bloodless hemispherectomy in the western United States at Children’s. These techniques, coupled with the optimal care provided by the ICU team have allowed this protocol to become a reality. Endoscopic Craniotomy for Craniofacial Anomalies The craniofacial team at Children’s, under the direction of Drs. Hal Meltzer and Steven Cohen, have established novel approaches for the treatment of craniofacial disorders. These minimally invasive endoscopic technologies allow for optimal cosmetic results while minimizing surgical duration, blood loss, and incision size. To date, 26 of these procedures have been performed at Children’s, making it one of the largest referral centers for endoscopic craniofacial procedures in the United States. Keyhole Craniotomy and Concurrent Endoscopy In addition to reducing blood loss, minimizing operative trauma to a child is a major point of interest for Children’s neurosurgical team. This has resulted in surgical techniques that minimize surgical trauma while maximizing outcome. An example is the keyhole approach for arachnoid cysts in children. Though classically treated either with shunting or craniotomy for fenestration, the team has developed a dime-sized keyhole approach for treatment of these lesions. Children’s Neurosurgery Division’s experience with this approach is the largest in the United States. Other minimally invasive strategies include supraorbital keyhole approaches for suprasellar tumors or interhemispheric conditions. These strategies depend significantly on the use of modern technologies such as concurrent 3D endoscopy which allows for the simultaneous use of the operating microscope and the endoscope. Concurrent techniques allow for multiple views of the anatomy despite a smaller operative corridor. The use of concurrent endoscopy will continue to be pursued clinically at Children’s. Patients are Referred to Pediatric Neurosurgery:
Children's Specialists Division of Neurosurgery © Children's Specialists of San Diego - Physician-to-Physician News - No.5, Spring 2003 |
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The neurosurgical team at Children’s is acutely aware of the need for less-invasive surgeries and has made significant efforts to provide for them by maximizing the potential for a variety of technologies and techniques. Some of these include bloodless surgery, endoscopic craniotomy for craniofacial disorders, keyhole craniotomy and concurrent endoscopy.
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