Our neurosurgical team performs a wide range of minimally invasive procedures, which result in less blood loss and, frequently, a faster recovery time. These procedures include bloodless surgery, endoscopic craniotomy for craniofacial disorders, keyhole craniotomy and concurrent endoscopy. Computer-assisted imaging is used to make the procedures as safe and effective as possible.
Our protocol for bloodless surgery allowed for the first bloodless hemispherectomy in the western United States to be performed at Rady Children’s. This protocol includes the preoperative administration of epoetin to maximize the hematocrit, along with the use of isovolemic or hypervolemic hemodilution, to lower patients’ hematocrit intraoperatively.
Endoscopic Craniotomy for Craniofacial Anomalies
Rady Children’s craniofacial team, under the direction of Hal Meltzer, M.D., and Steven Cohen, M.D., uses minimally invasive endoscopic techniques for the treatment of craniofacial disorders. These advanced techniques produce optimal cosmetic results (by allowing for small incisions) and reduce surgery time and blood loss. Our program is one of the largest referral centers for endoscopic craniofacial procedures in the United States.
Keyhole Craniotomy and Concurrent Endoscopy
To minimize surgical trauma to children, our team uses novel techniques, such as the “keyhole approach” for arachnoid cysts, and “supraorbital keyhole approaches” for suprasellar tumors or interhemispheric conditions. These techniques depend significantly on the use of modern technologies, such as concurrent three-dimensional 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.
Neurosurgical Integration of Computer-Based Technologies
Computer-based anatomic renderings are commonly used by radiologists and surgeons but have not been fully integrated into standard operating practice. Currently, the Neurosurgery Division uses two modalities for incorporation of the images into the operating room, allowing for the use of peri-operative and intra-operative imaging. Image-based workstations provide for three-dimensional reconstructions directly from computed tomography (CT) or magnetic resonance imaging (MRI) data.
To maximize the amount of anatomic information available to the surgeon during the procedure, the images can be displayed via a 3D HMD system or picture-in-picture modification that Rady Children’s has integrated into the surgeon’s optics of the operating microscope. The modifications allow the surgeon to operate under the microscope with the benefit of an endoscopic view absent the real-time use of an endoscope.
- Division of Neurosurgery
8010 Frost Street, Suite 502
San Diego, CA 92123
- Phone: 858-966-8574