My name is Dr. Amjad Anaizi. I'm a neurosurgeon at MedStar Georgetown University Hospital. I
see a variety of patients with different neurologic disorders ranging from brain
disorders to spine disorders. I have a specific interest in cranial base and brain tumors with
a variety of pathologies such as brain tumors, vascular malformations, brain aneurysms, cerebral
spinal fluid leaks, of a variety of patients. I think it's our responsibility to maximally
utilize the technology that we have available to us. It's our responsibility to the patients,
and so it's important that we continue to minimize the injury that the surgery causes
to the patient. And so, fortunately there has been a great deal of technology advances in
technology, and our approaches have changed according to the technology that we have
available to us. The thing that's most exciting is being able to address scary disorders, scary
to patients and quite frankly scary to a lot of physicians, using less invasive approaches and
allowing patients to recover much more quickly. That, that excites me, especially when patients
come in with having already heard or read about the way their disorders are typically treated
and then being able to offer them something that's less invasive and seeing the relief on
their face. It's, that's probably what excites me the most. You know, you treat people the way you
would want to be treated. You treat people the way you would want your mother or father, son, daughter,
brother, sister treated. And so every patient, I make recommendations that I would make for my
family member. I treat them like I would treat my family. And quite frankly, it you know often
takes more than one conversation to really deliver that information and address all of the patient's
questions because it's impossible for them to absorb all the information I give them on the
first visit and then have coherent questions for me. And so, it's not unusual for us to see patients
two, three, four times before we even operate. I think that the level of expertise here, both the
training that I've had as well as my colleagues in the Skull Base Center, provides some of the
most comprehensive cranial interventions that you will find in the country. I get up every morning
and do my job because I truly feel that it's a privilege that patients allow me to to take care
of them with these frightening brain disorders. I enjoy doing the operation. That is my passion.
And seeing patients recover from the operation postoperatively and following them postoperatively
from their ICU stay to when they get home, there's there's nothing that gives me more satisfaction.
Minimally invasive brain surgery and endoscopy brain surgery really refers
to a variety of techniques that have been developed to address brain disorders, while
minimizing the damage that we do to both the head, the face, and the brain.
The candidates for minimally invasive brain surgery continues to expand, and it really depends on the lesion, the location
of that lesion, and whether it's accessible using a minimally invasive procedure. But, it's
surprising the number of patients that are candidates, both adults and children.
I think it goes back to the point to being able to maximally utilize the technology that we have. And so, we
take out brain tumors through the nose without any incisions by introducing a specialized
camera called an endoscope through one nostril and then specialized instruments to reach that
tumor through the other nostril. And so, we use the normal passageways that you have to get to
the base of the skull and are able to remove very large tumors through a very small opening.
We use specialized instruments that are especially long, certainly longer than
we utilize in traditional operations. And, they are able to perform careful dissection. They're
different from the traditional tools that we utilize for open surgery, and again, it goes
back to the point of requiring specialized treatment so that you're actually accustomed
to using these tools that we have at our disposal. But the endoscope which gives
you a 2-D view and sometimes a 3-D view of our surgical cavity and the area that we're
operating on, and these special tools allow us to do a careful dissection and really utilize
those same concepts of safer section that we utilize on every brain operation whether
it's minimally invasive or or traditional. But, we're able to do it through the nose.
Minimally invasive brain procedures allow us to treat a variety of lesions
in different places in the brain. When we talk about endonasal endoscopic, so
specifically operations through the nose, those really refer to sinonasal malignancies as
well as brain tumors that are along the base of the skull, and so those are the
those are the tumors that are best addressed with the endoscopic endonasal procedures.
That's certainly a fear. Patients feel that they're gonna wake up with incisions across
their face or swelling or some kind of deformity. Typically, patients look exactly
the same as they did preoperatively. There's no external incisions in most cases. And I think
that's one important thing that the advances in endonasal endoscopic surgery have provided
is that now, in many cases and quite frankly in most cases, we're able to avoid any translational
incisions and the incisions across the face for resection of large sinonasal tumors.
Really depends on how extensive an endonasal endoscopic procedure you have, but the recovery
varies. For a standard pituitary tumor, pituitary adenomas, patients will stay in the hospital for
maybe a day or two, sometimes three, and then are able to sort of get back to their normal
lifestyle within two to four weeks. And, their appearance won't change. For somebody with a
large sinonasal malignancy or a very large brain tumor that we take out through the nose,
they often will have some packing. And, that packing can stay in for a week or so before it's
removed. That can sometimes create a little bit of discomfort, sort of feeling like you
have to breathe through your mouth rather than through your nose which is what most
of us are accustomed to. However, there isn't a great deal of pain associated
with it. You're not dealing with the pain of an incision or a craniotomy. And so, there's
there certainly still advantages that those minimally invasive endonasal procedures offer.
Endoscopic brain surgery specifically refers to the use of an endoscope which
is a specialized camera. It is a component of the minimally invasive procedures. I refer a
minimally invasive brain surgery or III think of minimally invasive brain surgery as procedures
that are reducing the collateral damage to the normal structures. That includes the endoscopic
procedures. The endoscope is really a tool that we utilize in minimally invasive brain surgery.
Minimally invasive brain procedures that do not utilize the endoscope
include keyhole craniotomies. So sometimes, we utilize specialized techniques where we
make small incisions, small bony openings in order to minimize retraction normal brain.
And, we utilize that for a variety of lesions including brain aneurysms and brain tumors.
Being able to deliver these minimally invasive procedures does require specialized training. So
once I completed my residency in Neurosurgery, I did specialized training and minimally invasive
complex brain and cranial base surgery. And, the colleagues that I work with, including my ENT
colleagues, have all been fellowship trained in their respective specialties. And so, it absolutely
does require a great deal of training and specialization to perform these procedures safely.
There are a variety of advantages that are offered by minimally invasive brain procedures.
These include a faster recovery postoperatively, a decrease in potential incisions or potentially
a lack of incisions, and decreased pain, quicker return to work, and hopefully a better quality
of life. And quite frankly, that's what we found is that in most cases when we're able to
deliver a minimally invasive alternative to a traditional procedure that that patient
has a better quality of life postoperatively, especially in the immediate post-operative period.
Comparing the recovery of minimally invasive brain procedures versus traditional brain procedures, those patients
both require a post-operative stay in the hospital, sometimes shorter for the minimally invasive
procedures. There is a lack of visible incisions often. We typically don't shave a patient's hair
if we can avoid it, and so a patient feels like they can go back to their normal life much more quickly
than somebody who has half their head shaved and has a large incision with a with a large
craniotomy. Having said that, there are patients that still require that. You know, the important
thing about being able to deliver safe minimally invasive procedures is recognizing when it's not
appropriate to utilize. And so, there are patients with certain tumors where I do not believe that
a minimally invasive keyhole craniotomy or an endoscopic procedure is the best thing for that
patient, and I'll tell them that. And, I do get patients that specifically ask me, can you do
this endoscopically? And, I give them a very honest answer. I tell them either, yes absolutely or no.
It's not unusual that we prepare a patient for a more traditional procedure, and we tell them listen
we're gonna do our very best to do this endoscopically or in a minimally invasive fashion but we
are going to be prepared in the operating room to do this in more traditional fashion, if necessary.
It's very unusual that we take with the plan for a minimally invasive procedure and then
transition to a traditional operation. That's extraordinarily uncommon.
Minimally invasive brain procedures and endoscopic endonasal procedures
are utilized to treat benign brain tumors, tumors of the cranial base, sinonasal
malignancies, cancers. We treat cerebral spinal fluid leaks. We treat aneurysm,
cerebral aneurysms, or arteriovenous malformations. So, it's really a variety of
disorders that lend themselves to treatment with minimally invasive brain operations.
One of the wonderful things about being at MedStar Georgetown University Hospital is that
we meet as a multidisciplinary team to discuss complex operations, and I'll tell patients that
in the clinic when I first meet them. I'll tell them, listen, you have a complex case. I'm gonna
discuss this with my team of either the skull base team at the skull base meeting or the tumor board
team to discuss complex brain tumors. And that really includes my ENT colleagues, my medical
oncologists, radiation oncologists, neuroradiologists, neuropathologists. There's really an extensive team
that's involved in those meetings, and I think it's important to be able to tell patients that listen
I'm not making unilateral decisions, that there is a benefit to discussing
this with other subspecialists that may be able to offer you an alternative to surgery.
There are often other surgeons involved in some of the minimally invasive procedures, especially the
endonasal endoscopic procedures which I perform with my one of my ENT colleagues, specifically
Dr. DeKlotz. So when we address pituitary tumors, pituitary adenomas, craniopharyngiomas, these
are often procedures that require that we traverse the sinonasal cavity. And
that's really an ENT specialty, and so, I think it's important that we work as a team. And then,
we are in the operating room together for the entirety of the tumor resection or the repair of
cerebrospinal fluid leak. You have two experienced surgeons in the OR at once taking care of you.
the diagnosis of a brain tumor does not require an operation necessarily. It really depends on
the type of tumor you have, the location of the tumor, and whether that tumor is
really causing symptoms or not. With advances in imaging, we've really diagnosed a lot of
patients with brain tumors that they never knew about. And for the number of patients I
operate on, there's a much greater number of patients that I follow and I see them every
six months or every year, and we follow their tumors. We don't necessarily have to operate on
every tumor. In fact, the majority of tumors that I see are really managed non-operatively.
There are alternatives to the treatment of brain tumors. One option is surgery,
but there are non-surgical options which includes radiation to some of
these brain tumors. And one great thing about MedStar Georgetown University
Hospital is that we offer the CyberKnife radiosurgery as well as proton therapy.
Proton therapy is a great non-surgical option for
specific patients with specific types of skull base tumors, especially in children.
It's not unusual that patients come in and see me as a second opinion. They've seen one
physician that has offered a more traditional operation. It's not the wrong operation. It's an
alternative. And I would never, I think it's important that physicians do the
operation that they feel comfortable doing. So certainly, many physicians would disagree that a
minimally invasive procedure is an option because quite frankly they don't have the experience in
doing these procedures. So, it's not unusual that I see a patient that's seen offered a
traditional operation then all of a sudden we say listen we could take this out through the nose or
through a minimally invasive keyhole craniotomy. And at that point, it's confusing for the patient.
They've seen one specialist that's told them they need to have it done one way and that's the only
option. If they see another specialist that tells them they should have it done a different way. So, I
feel for the patients. It can be very confusing. You're dealing with the diagnosis of a brain
disorder. That's a stressful time in your life, and now, you're seeing two specialists that are telling
you two different things. So the thing that has to be understood is that these are relatively new
procedures, that very few neurosurgeons have actually undergone the specialized training
that's required to do these procedures, and a neurosurgeon that has not undergone that
specialized training is not going to recommend a minimally invasive procedure and shouldn't because
that's not a procedure that they feel comfortable doing. But fortunately, you know, many of us here
specifically myself and my ENT colleagues have undergone that specialized training
and feel comfortable doing these minimally invasive procedures here at MedStar Georgetown.