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Endoscopes may look like thin pieces of tubing, but these revolutionary surgical tools can provide detailed video images of the brain, allowing visualization of brain structures through a skin incision the width of your thumb and an entry into the brain that's smaller than a pushpin. Small instruments that can cut, sample or destroy abnormal tissue or tumors can also be passed through these tubes, which allow intricate surgery to be performed with little or no trauma.
Most important, neuroendoscopes have helped ease the burden of brain surgery for hundreds of patients at the University of Chicago Medicine. Instead of suffering large incisions and lengthy hospital stays, patients who have endoscopic brain surgery have to endure only one or two small incisions. They are often free to go home a day or two after surgery.
For several years, our premier brain surgeons have been using endoscopes to treat hydrocephalus, which is a dangerous buildup of spinal fluid in the ventricles, or fluid spaces, of the brain. Our brain surgeons are also successfully diagnosing and treating brain tumors using endoscopic approaches. These minimally invasive operations can benefit people of all ages — from tiny newborns to older adults.
Traditional brain surgery requires opening up the skull to access the brain. In contrast, endoscopic approaches only require one or two dime-sized holes. The surgeon then guides the endoscope through the brain ventricles until it reaches the problem area — the tumor or blockage causing hydrocephalus. Throughout the surgery, the tiny video camera on the end of the endoscope projects large-scale images of the inside of the brain onto a computer screen, helping the surgeon see what is going on.
The treatment depends on the problem. For instance, if there's a blockage causing hydrocephalus, the surgeon can create a small bypass hole so the spinal fluid can flow around the blockage, curing the hydrocephalus. When used for the most common kind of blockage causing hydrocephalus — aqueductal stenosis — this operation is called an endoscopic third ventriculostomy or ETV.
In addition to less pain and a quicker recovery, endoscopic approaches cause less trauma to the brain than open brain surgery. Another major advantage: endoscopic surgery often will reduce the need for a spinal fluid shunt. Usually surgeons have to implant a shunt — or a tube to drain away the blocked spinal fluid — to cure hydrocephalus. While shunts are vital pieces of equipment, they are not yet 100 percent perfect. The majority of shunts eventually have to be replaced because they break or an infection develops, which could require another operation down the road.
Not all brain surgeries can be performed using endoscopic approaches. When open brain surgery is necessary, our world-class surgeons rely on the latest technology to help minimize the patient's pain and trauma. Using data from CT or MRI scans and other brain imaging tests, our staff creates detailed 3-D computer models of a patient's brain. These sophisticated stereotactic techniques — some of which were developed at UChicago Medicine — help our brain surgeons pinpoint the exact location and size of a brain tumor or other abnormality.
As a result, open brain surgeries today require much smaller incisions than they used to. In the past, a surgeon would have to make a 10-centimeter incision to locate and remove a two-centimeter tumor. Today, the operation only requires a one- to two-centimeter opening.
The benefits to the patient are obvious: less pain, a quicker recovery, fewer side effects and less brain trauma.
Physicians and patients from around the world contact our brain surgeons for their opinions on endoscopic brain surgery. Our brain surgeons have performed hundreds of these procedures and have written textbook chapters and peer-reviewed papers on the subject. They have also taught other surgeons how to successfully use these approaches to treat hydrocephalus and other problems.
In addition to caring for patients, UChicago Medicine surgeons are also world-class researchers. They are always looking for new ways to use endoscopic approaches to reduce the trauma of brain surgery.