4-Year-Old Becomes 1000th Patient To Have Skull-Base Tumor Removed Through The Nose By University Of Pittsburgh Medical Center Surgical Team

Main Category: Cancer / Oncology
Article Date: 06 May 2008 - 3:00 PDT

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Marking unparalleled experience, a University of Pittsburgh Medical Center (UPMC) surgical team recently performed its 1000th endonasal case - the complete removal of a skull-base tumor from a 4-year-old girl entirely through her nose, without incisions and without scarring.

The young patient, who lives in the Shenandoah Valley region of Virginia, was diagnosed with a nasal dermoid cyst, extending into her skull. A traditional craniotomy, a procedure both potentially disfiguring and disruptive to her major growth centers, was a conventional option to remove this tumor, but the UPMC surgical team elected to operate through the nose and remove the tumor without an incision. Following a short stay at Children's Hospital of Pittsburgh of UPMC, she returned home with her family last week and is experiencing a full recovery without limitations.

"What we have learned from these thousand cases, including more than fifty children, is that the potential for endonasal brain and skull-base surgery is significant," said Amin Kassam, M.D., chair of the Department of Neurological Surgery, UPMC, professor of neurological surgery, University of Pittsburgh School of Medicine, and part of the pioneering team that refined and expanded the scope and complexity of tumors that now can be treated endonasally.

Blending the specialties of neurosurgery and otolaryngology, Dr. Kassam, along with Carl Snyderman, M.D., and Ricardo Carrau, M.D., both UPMC otolaryngologists and professors of otolaryngology and neurological surgery at the University of Pittsburgh School of Medicine, began investigating endoscopic transnasal brain surgery in 1998 and have played a pioneering role internationally to visualize these lesions and custom-design instruments to reach and safely remove them.

Their work originated with a technique designed to reach pituitary tumors but which now enables access to tumors at the base of the skull, central brain and top of the spinal cord by operating through the nose and nasal sinuses, typically leaving no scars and few, if any, lingering side effects.

This endonasal work, combined with a new minimally invasive technique developed at UPMC - the endoport - which is used to reach tumors within the substance of the brain and within its fluid spaces, enables the UPMC team to reach tumors often thought to be very difficult and risky to reach through conventional surgery techniques. The complexity of the treatable tumors and the experience of the surgical team represent a unique international experience.

"There is a big difference between hard-to-reach tumors and inoperable tumors," said Dr. Snyderman. "We've learned to navigate the anatomy to reach farther and deeper, giving hope to many adult and pediatric patients where there once was none."

About the UPMC's Minimally Invasive endoNeurosurgery Center (MINC)

Surgeons at UPMC's Minimally Invasive endoNeurosurgery Center can treat cancer as well as vascular, nerve, spinal, neurological and other conditions using powerful imaging technology and special surgical techniques and tools to visualize and access hard-to-reach areas. Since minimal or no incisions are needed, patients typically can return to their normal activities, sometimes within hours or days of surgery.

UPMC's Minimally Invasive endoNeurosurgery Center