Single-Port Intracranial Endoscopy

Single-port intracranial endoscopy

Despite the complicated name, an advanced technique is making brain surgery simpler

In May, Sam Sandler had a 3.5 cm, noncancerous brain tumor removed from the deepest part of his brain at the George Washington University Hospital. Surgery was on a Tuesday and he was home by Friday evening. Hard to believe? Not with single-port intracranial endoscopy.

Intracranial endoscopy uses high-definition imaging and paper-thin fiber optic instruments to inspect, treat and remove tumors and cysts from the brain. GW Hospital neurosurgeons take this technique a step further by conducting the procedures through a single opening, or port – the size of a nickel – in the patient’s skull. This minimally invasive approach streamlines the procedure immensely.

The best location for single-port entry is guided by the surgeon’s knowledge of functional anatomy, assisted by a StealthStation® S7® surgical navigation system. The endoscope system – which is the diameter of a pencil, or at most, a Sharpie® marker – is inserted to create an “operative corridor.” A microscopic fiber optic camera provides high-definition visualization.

According to Zachary Litvack, MD, MCR, Assistant Professor of Neurosurgery and Otolaryngology, Co-director Endoscopic Pituitary and Skull Base Surgery Program, since the instruments used to remove the tumor pass through the endoscope, there is no additional injury to the normal parts of the brain.

“You used to have to go through the brain or between the brain’s two hemispheres to get to the ventricular system,” explains Anthony Caputy, MD, chairman, Department of Neurosurgery, Professor of Neurosurgery, referring to the brain’s fluid-filled cavities where tumors are often located. With the old technique, despite the positives, you were “putting the nonpathological parts of the brain at risk. Patients would spend days or weeks recovering in the ICU,” he says.

Patient Sam Sandler was relieved to learn that his surgery only required two or three minor incisions, all of which would be easily camouflaged in the hairline. He and his wife Betty credit his surgical team for their “incredible” work and fast action.

“Timing was critical for Sam because the tumor was blocking the flow of spinal fluid to the rest of his brain,” says Betty. Her husband was seen last minute in Dr. Litvack’s clinic on a Friday. The following Tuesday he was in the operating room, and a week after his clinic visit he was back home. “The surgeons, the nurses and the whole GW team were just amazing from day one,” she says, “and that makes a world of difference.”

Promising future for deep brain stimulation

Deep brain stimulation (DBS) has been used to treat Parkinson’s disease and other movement disorders like essential tremor for more than a decade in the United States. By implanting very thin wire electrodes in the brain connected to a device like a pacemaker implanted in the chest, DBS stimulates near the part of the brain where the disorder originates. The treatment – only used when other therapies such as medication have failed – is being studied for patients with Alzheimer’s disease, epilepsy and depression.

“The field of deep brain stimulation is changing very quickly,” says Donald Shields, MD, PhD, MBA, FAAN S, Assistant Professor of Neurosurgery. “We’re learning a great deal, most recently about psychiatric applications, for example. The usefulness and need for DBS in some patients will lead to more and more clinical applications.”

This Draft Has Sidebar Blocks
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Anthony Caputy Anthony Caputy, MD
Chairman, Department
of Neurosurgery,
Professor of Neurosurgery
Zack Litwack Zachary Litvack, MD, MCR
Assistant Professor
of Neurosurgery
and Otolaryngology, Co-director Endoscopic Pituitary and Skull Base Surgery Program
Donald Shields Donald Shields, MD, PhD, MBA, FAANS
Assistant Professor
of Neurosurgery
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The Neurosciences Institute at the George Washington University Hospital is one of the premier neurological centers in the world. Patients come for comprehensive care by internationally recognized experts. The team treats patients with neurological problems, including brain tumors, epilepsy, aneurysms, stroke, Parkinson’s disease and multiple sclerosis, as well as spine and neuromuscular issues.

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Deep Brain

Deep Brain Stimulation (DBS) is a treatment to correct abnormal electrical activity in the brain that causes neurological movement disorders, including Parkinson's disease.

Learn more >

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Intracranial Endoscopy


The George Washington University Hospital is owned and operated by a subsidiary of Universal Health Services, Inc.(UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.          

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