26 November 2014
Surgical teamwork results in removal of rare head and neck tumor from 15 year-old boy
When the parents of a 15 year boy noticed his recurrent nose bleeds, they initially thought little of it. However, as the bleeding became increasingly severe, they brought him to a local doctor. An MRI scan revealed the cause of their son's nose bleeds – a large tumor in the back of his nose and throat. The family's local doctor referred the patient to Citizens Hospital for further assessment and possible surgery to remove the tumor.
When the boy arrived, a multidisciplinary team of experts in rhinology (study of the nose and sinuses), skull-base and brain onco-surgery, as well as neuro radiology and pediatric anesthesia, first prescribed a CT scan so that they could get a better picture of the tumor’s overall size, shape and location. The CT scan would also determine the tumor’s extensions.
Quickly the team identified an angio fibroma, a very rare skull-base tumor with the potential to cause not only nose bleeds but more critical problems such as bone damage, facial deformity or even blindness. Almost immediately, they realized the challenges ahead in treating this patient, as the tumor had grown so large that it surrounded the sinus bones and protruded into the boy's brain cavity.
"Skull-base tumors like this one are located at the junction of the brain and upper neck. The area is difficult to reach and also contains many important blood vessels and nerves, leaving little margin of error in surgery" said Dr. Sashikanth J, MD, Senior Consultant and Head of Department, ENT, Head and Neck Surgery, Citizens Hospital. "The traditional approach requires open surgery, where doctors cut through bones in the face or the skull. Even after successful tumor removal, the risks of this approach are high, and there is also chance for life-long facial damage for the patient. However, combining the skills of several members from our team, we were able to remove it using a minimally-invasive approach," he added.
Accomplishing such a challenging surgery using a minimally-invasive method requires surgical expertise, a high degree of collaboration between expert doctors from different specialties and use of sophisticated medical technology. "Before performing this surgery, we first obtained a CT scan of the patient's brain and loaded it into our operation theater's state-of-the-art navigation system, which works like a GPS for the skull and brain. It gives our surgeons very precise information about the complex anatomy of the skull and adds a degree of safety for patients," said Dr. Sashikanth J, MD.
The next step of the procedure occurred in the Citizens Hospital catheterization lab. "I performed an angioplasty to locate and temporarily cut the blood supply to the area of the neck and brain on which we planned to operate. With the proper equipment and monitoring, doing so is safe and also minimizes bleeding risk, which can be very severe in this type of tumor," Dr. Ateeq Rahman, MD, Consultant Interventional Neurologist, Citizens Hospital.
After confirming the success of the cath lab procedure and working in tandem, Dr. Sashikanth and Dr. Ajay Reddy, MD, Consultant Neurosurgeon, Citizens Hospital, performed the entire complex surgery using endoscopes. Dr. Jonnalagadda removed a portion of the tumor through the patient's nose, and Dr. Ajay Reddy removed the remainder of it from the dura, the outer covering of the brain, also using an endoscope instead of conventional methods. The surgery itself took over five hours, and the patient was able to leave the hospital only two days after its completion, without any nasal packing or skin sutures.
"There are two important take-aways from this case. First, a young patient came to the hospital with a serious condition and left safe and healthy after only a few days. Second, that was possible only because a team of doctors worked together to form a plan, approach the treatment in stages and use all of the technology options available to us," commented Dr. Sashikanth J. "This is the essence of modern medicine – groups of doctors working together as one to give patients the best outcomes," he closed.
About Citizens Hospital
Citizens Hospital provides protocol-driven healthcare based on the latest medical evidence across a broad range of medical specialties for inpatients and outpatients. It coordinates care in a way that emphasizes the needs of patients first. Citizens Hospital values quality and invests in technology proven for clinical effectiveness. Its medical staff consists of experts recognized not only for their clinical abilities but their ability to work as a team to get the best outcomes for patients and extend top-level care with compassion. The hospital places a high emphasis on exceeding rigorous quality benchmarks related to safety and performance. It has struck strategic partnerships with firms possessing similar objectives. These aspects of Citizens Hospital combine to drive its primary mission of bringing the world's top healthcare standards to India.
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