Imagine a tiny pea at the bottom of a bowl of Jell-O. Now, imagine trying to remove that pea without disturbing the Jell-O around it. That’s how Rashid Janjua, M.D., assistant professor of neurosurgery, and Drew Plonk, M.D., assistant professor of otolaryngology, at Wake Forest Baptist Medical Center describe the precision required to remove pituitary tumors at the base of the brain.
Now, new tools and technology are allowing Janjua, Plonk and other surgeons at Wake Forest Baptist to remove these and other skull base tumors even more precisely without having to make an incision on the head. They are able to perform brain surgery through the nose.
The team of surgeons from two specialties takes a multidisciplinary approach in the technique offered at Wake Forest Baptist. Plonk is joined by assistant professor of otolaryngology, John Clinger, M.D., on the otolaryngology side, and Janjua is joined by John Wilson, M.D., professor of neurosurgery, on the neurosurgery side. Together all four make up the endoscopic skull base surgery team.
In the operating room, Plonk and Clinger guide an endoscopic camera through one nostril to the floor of the skull. Once this exposure is established inside the nasal cavity, Janjua or Wilson will open the bony floor of the skull and begin removing the pituitary tumor through instruments working from the other nostril. In the same fashion, other tumors arising from the base of the skull or defects in the bone that result in the brain protruding into the nose or sinuses, can be treated in this minimally invasive fashion.
“With the conventional methods, the neurosurgeon relied on a microscope to guide the removal of the tumor,” said Plonk. “This technique allows an endoscopic camera to be right at the tumor which gives a complete view of the tumor allowing the surgeon to ensure removal of all of it.”
The endoscopic skull base surgery team started using this technique in 2012 and has continued to improve upon it as the only medical center in the Triad offering this surgery technique.
Last month was their 30th case. Donna Crigger of Wytheville, VA developed a pituitary tumor that was discovered after a routine eye exam. Crigger noticed large blind spots in her vision during the exam and an MRI was ordered. The test results showed she had a large pituitary tumor. Although the tumor was benign, it was pushing on her optic nerve causing the tunnel vision.
Janjua and Plonk performed the surgery and removed her tumor last month by going through her nose to the tumor instead of opening up her skull.
“It was just a blessing in disguise,” said Crigger about catching the tumor early during an eye exam. “I no longer have the vision problems thanks to the removal of the tumor, and I don’t have any side effects from the surgery.”
The surgery technique offered a quicker recovery time compared to the conventional methods that involve cutting into the skull.
“This allows us to be more thorough in tumor removal,” said Janjua. “Plus, the patients usually are sitting up and having dinner that same night. With these techniques, we are able to discharge them from the hospital sooner, and they are back at home with their loved ones and at work earlier than they would’ve been before.”
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