Surgical Videos by
Dr. JFM
Watch real surgical procedures performed by Dr. Fernandez-Miranda at Stanford. These videos demonstrate minimally invasive endoscopic endonasal and advanced open skull base techniques for pituitary tumors, craniopharyngiomas, chordomas, meningiomas, vestibular schwannomas, epidermoid tumors, pineal tumors, gliomas, and other complex skull base and brain lesions.
These surgical videos contain real operative footage intended for patient education and healthcare professionals. Viewer discretion is advised. Some videos may require YouTube sign-in due to content restrictions.
Dr. Fernandez-Miranda has performed over 2,000 endoscopic endonasal operations for pituitary tumors and other skull base lesions. The endoscopic endonasal approach is a minimally invasive technique that accesses the pituitary gland through the nose, avoiding any external incisions. Below are examples demonstrating this approach for different types of pituitary tumors.
Endoscopic Endonasal Approach for Pituitary Tumor Removal
Dr. Fernandez-Miranda narrates this simulation demonstrating the step-by-step endoscopic endonasal approach to pituitary tumor removal and his pioneering technique for medial wall resection of the cavernous sinus
Demonstration of Dr. Fernandez-Miranda's pioneering technique for medial wall resection of the cavernous sinus — the innovation behind the cure of Cushing's disease in this young patient after previous failed surgeries.
This prolactinoma patient was first treated with cabergoline but developed side effects with worsening depression symptoms. Recent innovations introduced by Dr. Fernandez-Miranda allowed for complete tumor resection, with much improved quality of life and normal prolactin levels now 5 years after surgery.
Acromegaly is caused by a growth hormone-secreting pituitary tumor that invades the cavernous sinus in many cases. Traditional surgical approaches have reported remission rates of only 50-60%. Dr. Fernandez-Miranda pioneered the technique of medial wall resection of the cavernous sinus, achieving biochemical remission in most patients — including those who had unsuccessful surgery elsewhere. This represents the highest reported remission rate in the field.
Demonstration of Dr. Fernandez-Miranda's pioneering technique for medial wall resection of the cavernous sinus — the innovation behind his record 90%+ biochemical remission rate for acromegaly. Here 3 case examples with different patterns of invasion requiring specific surgical techniques as described by Dr. Fernandez-Miranda.
The tumors causing Cushing's disease are often very small (microadenomas), making them difficult to detect on MRI. In many cases, the tumor is not clearly visible, and the surgeon must rely on anatomical knowledge and intraoperative judgment to locate and remove it. Additionally, these tumors frequently invade the medial wall of the cavernous sinus — a critical factor that many surgeons fail to recognize, leading to incomplete resection and persistent disease.
Prolactinomas are the most common type of pituitary tumor, and most are effectively treated with medication (cabergoline or bromocriptine). However, surgery becomes the best option when patients experience intolerable medication side effects, when the tumor does not respond to medical therapy, or when patients prefer a definitive surgical cure over lifelong medication.
Dr. Fernandez-Miranda has introduced surgical innovations that allow complete tumor resection for prolactinomas — including those invading the cavernous sinus — with excellent rates of hormonal normalization and preservation of pituitary function.
Craniopharyngiomas are among the most challenging brain tumors, arising from the pituitary stalk near the hypothalamus and visual pathways. Dr. Fernandez-Miranda has developed endoscopic endonasal techniques that achieve complete tumor resection — including cases previously considered inoperable — while preserving hypothalamic, cognitive and visual functions. Complete resection is especially important in children, where long-term outcomes depend on minimizing the need for additional treatments.
Endoscopic endonasal removal of a complex craniopharyngioma in a pediatric patient, demonstrating the subpial dissection technique for hypothalamic and pituitary stalk preservation. Tumor was completely removed and patient is tumor-free 5 years after surgery.
Chordoma is a rare bone cancer of the skull base that affects approximately one in a million people. Dr. Fernandez-Miranda is one of very few neurosurgeons worldwide with true expertise and innovation in chordoma surgery. He has pioneered endoscopic endonasal techniques for skull base chordomas, describing novel surgical approaches and anatomical nuances. Complete surgical resection is associated with longer survival and reduced recurrence, making surgeon expertise a critical factor in outcomes.
Endoscopic endonasal approach for resection of a complex clival chordoma, demonstrating the minimally invasive technique for this rare skull base cancer.
Chondrosarcomas are rare cartilaginous tumors that can arise at the skull base. Like chordomas, they require expert surgical management for optimal outcomes. Dr. Fernandez-Miranda uses advanced endoscopic endonasal and open skull base techniques tailored to the specific location and extent of each tumor, with the goal of complete resection while preserving critical neurovascular structures.
Skull base meningiomas are the most challenging meningiomas because they arise near critical nerves and blood vessels at the base of the brain. Dr. Fernandez-Miranda selects the most effective and least invasive approach for each patient — including endoscopic endonasal, open skull base, and combined approaches — tailored to the specific tumor location. The videos below demonstrate the range of techniques used.
Complete endoscopic endonasal removal of a large central skull base meningioma — a case most neurosurgeons would approach through open craniotomy. Total resection achieved through a minimally invasive corridor, navigating critical nerves and vessels.
Posterior clinoid meningioma removed via open middle fossa transcavernous approach — where a subtle shift in tumor location favors an open over endonasal corridor. Features Dr. Fernandez-Miranda's self-designed extensible microdissectors, adaptable to both approaches, reflecting his ability to select the optimal strategy for each patient.
Vestibular schwannomas (acoustic neuromas) grow on the hearing and balance nerve, directly adjacent to the facial nerve and brainstem. Treatment may involve microsurgery, CyberKnife radiosurgery, or a combination of both. When surgery is indicated, Dr. Fernandez-Miranda selects from retrosigmoid, translabyrinthine, and middle fossa approaches — working in close collaboration with Stanford's neuro-otology team. His use of subarachnoid and subpial dissection techniques allows precise separation of tumor from the facial and cochlear nerves, even in large tumors where the nerve is thinned or splayed over the tumor surface.
Epidermoid tumors are rare, benign growths that develop from embryonic skin cells trapped inside the skull. Despite their slow growth, they are among the most technically demanding tumors to remove because their thin, pearly capsule is often tightly adherent to cranial nerves, blood vessels, and the brainstem. Complete resection is essential to prevent recurrence. Dr. Fernandez-Miranda combines meticulous microsurgical dissection with endoscopic-assisted inspection to identify and remove tumor hidden in the crevices of the skull base, achieving the most complete resections possible while preserving neurological function.
Pineal tumors arise in one of the deepest and most difficult-to-reach locations in the brain. They include a diverse group of tumor types — pineocytomas, pineoblastomas, germ cell tumors, and others — each requiring a different treatment strategy. Accurate diagnosis is critical because some pineal tumors, particularly germinomas, are best treated with radiation and chemotherapy alone and do not require surgical resection. When surgery is needed, Dr. Fernandez-Miranda uses specialized approaches including the supracerebellar infratentorial corridor to reach the pineal region with minimal brain manipulation.
Gliomas in eloquent brain areas — regions controlling language, movement, memory, and vision — present an extraordinary surgical challenge. The medial temporal lobe, insular cortex, and dominant-hemisphere language areas are locations where many surgeons consider tumors inoperable. Dr. Fernandez-Miranda's pioneering research in white matter anatomy and brain connectivity translates directly into safer surgery. Using awake craniotomy with real-time cortical and subcortical mapping, preoperative white matter tractography, and meticulous microsurgical techniques, he achieves maximal safe resection of complex gliomas while preserving neurological function and quality of life.