Ohio State Surgeons Pioneer Removal Of Skull-Based Tumors Through the Nose and Mouth

March 06, 2012

COLUMBUS, Ohio – Surgeons at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) Cranial Base Center have developed a minimally invasive technique to reach and remove skull-based tumors through the nose or mouth, sparing patients from considerable pain from traditional open surgery, and allowing for a quicker recovery.

The procedure combines endoscopic endonasal surgery with minimally invasive robotic surgery to treat many tumors that are difficult to reach, including those considered to be inoperable. The endoscopic endonasal approach is a minimally invasive skull base technique that gives surgeons access to the base of the skull, intracranial cavity and top of the spine by operating through the nose and paranasal sinuses.

"These are two techniques that are basically complementary, and it makes sense to combine the technical precision of each method and the expertise of Ohio State's surgeons to reach the entire tumor," said Dr. Ricardo L. Carrau, professor of otolaryngology - head and neck surgery at OSUCCC – James. "To our knowledge, this is the first time the two techniques are used in patients."

"Under normal circumstances, a patient's face would be cut open or even peeled back to reach such a tumor," said Dr. Daniel M. Prevedello, director of Ohio State's Minimally Invasive Cranial Surgery Program.

Prevedello is one of only a few neurosurgeons worldwide trained to conduct the endoscopic endonasal procedure. Its many benefits for patients include leaving no facial incisions or scarring, causing less trauma to the brain and nerves and having fewer side effects and quicker recovery times.

Using tiny surgical instruments, a brain surgeon and an ear-nose-and-throat surgeon work through both nostrils while using the robot through the mouth. High-definition cameras and high-tech equipment similar to a GPS map of the brain allow them to find and remove tumors – all through the patient's nose and mouth.

The surgical team has successfully performed the combined techniques to treat two patients with different types of tumors. Thomas Morris of Washington Court House, Ohio, had suffered for years with ear aches that were caused by an adenoid cystic carcinoma, a malignant tumor arising from the glands in the head and neck region that grows along the nervous system. This type of cancer often spreads to distant sites, including lungs and bones, said Prevedello.

"In this case, the tumor was invading the side of his skull going in the direction of the Eustachian tube, which is the structure that prevents problems in the middle ear," said Prevedello.

In the past, to surgically remove an ACC tumor the surgeon would have to access the malignancy through the roof of the mouth, also known as the soft palate, which would result in facial scars and a much longer recovery.

The second patient, Margaret Handshoe of Wapakoneta, Ohio, had suffered more than one year with severe headaches, vision problems and fatigue caused by a malignant cranial base tumor called a chordoma, said Carrau.

"The traditional approach for this type of lesion of the skull base requires incisions on the face, on the side of the nose and the roof of the mouth," said Prevedello. "And those cuts can cause problems for the patients. When we do the minimally invasive techniques, we avoid those cuts, and the patients tend to heal faster and with fewer problems."

Dr. Enver Ozer, assistant professor, department of otolaryngology - head and neck surgery, explained that approaching the skull-based tumors from the oral cavity with robotic instruments allows surgeons to use a natural orifice as a passage to reach the tumors, and thereby avoiding disfiguring external incisions on the face.

The use of minimally invasive robotic-assisted instruments offers a number of advantages, including three-dimensional visualization, tremor-free surgical tools and magnified vision.

"This type of surgery offers improved quality of life and functional benefits for the patients," said Ozer. "We are very excited about its potential and our ability to treat patients with less pain and a faster recovery."

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute strives to create a cancer-free world by integrating scientific research with excellence in education and patient-centered care, a strategy that leads to better methods of prevention, detection and treatment. Ohio State is one of only 40 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers and one of only seven centers funded by the NCI to conduct both phase I and phase II clinical trials. The NCI recently rated Ohio State's cancer program as "exceptional," the highest rating given by NCI survey teams. As the cancer program's 210-bed adult patient-care component, The James is a "Top Hospital" as named by the Leapfrog Group and one of the top 20 cancer hospitals in the nation as ranked by U.S. News & World Report.

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Contact: Eileen Scahill, Medical Center Public Affairs and Media Relations, 614-293-3737, or Eileen.Scahill@osumc.edu

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