Endoscopic surgeons S.S. Dhandapani and Rijuneeta at the PGIMER here have performed total removal of complex planum meningioma, adherent to neurovascular structures, through the nose of two patients using 4K endoscopy system.

The patients, a 48-year-old male and a 46-year-old female were referred to the Postgraduate Institute of Medical Education and Research (PGIMER) with complaints of decreased vision. Their MRI scans revealed planum meningioma of 3 cm size at the base of the skull, abutting critical vascular structures such as anterior cerebral and internal carotid arteries on both sides, as well as neural structures such as both optic nerves and pituitary stalk.

These tumours are usually operated on through open surgery, and the remaining part is treated with radiation. Over the last few years, simple tumours are being removed through the nose endoscopically by neurosurgeons teaming up with ENT surgeons.

However, endoscopic removal through the nose is highly challenging in complex meningiomas close to neurovascular structures. Dhandapani chose the endonasal corridor, as the skull opening and brain retraction are avoided if operated through the nose. The team studied the patients in detail using CT angiography navigation and planned for endoscopy. A 4K endoscope system, installed recently in the Neurosurgery Department, was used for this purpose.

Compared to full HD, the 4K system provides four times better resolution. The tumours were very firm and had to be dissected meticulously from the blood vessels of the brain, using angled endoscopes and could be finally removed totally through the nose.