COLUMBUS, Ohio – Earlier this year, Tricia Wharton gave birth to a healthy baby girl and underwent successful skull-based surgery to remove a large malignant tumor from her sinus cavity – all within the same week.
Even more remarkable – she has no visible scars on her face from the extensive surgery to remove the tumor.
During her pregnancy, Wharton, 33, of Logan, Ohio, started having sinus pain and numbness on the left side of her face. Her pregnancy was 25 weeks along when doctors at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) diagnosed Wharton with a rare tumor called an adenoidsystic carcinoma that was quickly growing in her sinus cavity.
The surgical team of experts at the Ohio State Cranial Base Center worked with Wharton's obstetrician to carefully monitor both Wharton and her unborn baby as they developed a plan to treat the mother while protecting the baby.
"This was a delicate balancing act, and a real collaboration between our team and her obstetrician," said OSUCCC – James head and neck cancer surgeon Dr. Ted Teknos, who also is a part of the Cranial Base Center team caring for Wharton.
The baby, named Sarah, was delivered by cesarean section at the Ohio State University Medical Center at 32 weeks, when her chance of survival was greatly improved.
One week later, during a five-hour operation, Teknos and other members of the Ohio State Cranial Base Team surgically removed the softball-sized tumor through Wharton's nose using an endoscopic endonasal procedure that spared her considerable pain. As part of Wharton's treatment, a prosthetic roof of her mouth was implanted, and she will soon start radiation treatments, said Teknos. Her prognosis is good, added Teknos, who is the David E. and Carole E. Schuller Chair of Head and Neck Oncologic Surgery at OSUCCC – James.
The endoscopic endonasal approach is a minimally invasive neurosurgical technique that gives surgeons access to the base of the skull, intracranial cavity and top of the spine by operating via the nose and paranasal sinuses.
Normally, a patient's face would be cut open or even peeled back to reach such a tumor, said Dr. Daniel Prevedello, director of Ohio State's Minimally Invasive Cranial Surgery Program.
Prevedello is one of only a few neurosurgeons worldwide trained in this procedure. There are numerous benefits to this approach. It allows surgeons to treat many tumors that are difficult to reach, including those considered to be inoperable. It leaves no facial incisions or scarring, causes less trauma to the brain and nerves and has fewer side effects and quicker recovery times.
"By avoiding facial incisions, patients tend to heal faster and recover faster. So most of the time patients are discharged earlier, in comparison to standard approaches," said Prevedello, who helped pioneer the technology and techniques used at Ohio State, and who is training other surgeons to use the approach. Prevedello, Teknos, Dr. Bradley Otto and Dr. Matthew Old comprise Ohio State's Cranial Base Team.
Using tiny surgical instruments, a brain surgeon works in one nostril while an ear-nose-and-throat surgeon works in the other nostril. Using high-definition cameras and high-tech equipment similar to a GPS map of the brain, they find and remove tumors – all through the patient's nose.
Recently, Prevedello and Otto traveled to Brazil to perform the endoscopic endonasal approach on two patients, including a high-ranking government official. Their expertise in this approach provides access for management of these conditions:
benign intracranial tumors (pituitary, adenoma, meningioma, craniopharyngioma and schwannoma)
- malignant cranial base tumors (chordoma, chondrosarcoma, olfactory neuroblastoma)
- benign cranial base disorders encephaloceles, mucoceles, cerebrospinal fluid leak, osteomas)
- benign sinonasal tumors (inverted papilloma, nasal polyps)
- malignant sinonasal tumors (squamous cell carcinoma, adenocarcinoma)
The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (cancer.osu.edu) is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top cancer hospitals in the nation, The James is the 205-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC – James is one of only seven funded programs in the country approved by the NCI to conduct both Phase I and Phase II clinical trials.
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