After Near Suffocation, Brain Tumor Removed Through Patient's Nose
Initially, 64-year-old Ismael Villa didn’t think much of it when he began experiencing slight difficulty swallowing. The devout Jehovah’s Witness prayed it would pass, but in the coming months his symptoms progressed to include severe eye pain and ear aches. A brutal bout of labored breathing landed him in the emergency room of John M. Stroger Cook County Hospital. There, imaging of the head and neck revealed a large bi-lobed brain tumor, meaning that the tumor was two-sectioned. One portion extended into the base of the brain and the other into the base of the skull, and it was beginning to suffocate him. Immediate intervention was needed. Adding to the difficulty of the intricate removal were Villa’s firm wishes not to be transfused with donated blood—a strict provision of his religious beliefs. The complexity prompted county physicians to refer Villa’s case to the multidisciplinary experts of Northwestern Memorial Hospital’s Endoscopic Cranial Base Center and the newly formed Northwestern Brain Tumor Institute. There, a course was set to resect the deadly tumor without a single incision into his skull—surgeons would remove the two-part growth through his nose. This minimally invasive treatment option allowed clinicians to use reserves of Villa’s own blood during the procedure, preserving conditions of his faith.
“Complex skull base tumors are a challenge due to their encasement in treacherous areas of the brain where the slightest touch can result in major nerve damage,” says James P. Chandler, MD, neurosurgeon, co-director of the new Institute and associate professor of neurological surgery at Northwestern University Feinberg School of Medicine. “In the past, eliminating a tumor of this makeup would have required a very disfiguring, face-splitting surgery.”
Villa’s surgical team included Robert Kern, MD, the hospital’s Chair of Otolaryngology and professor of otolaryngology at the Feinberg School of Medicine, who adds that advancements in skull-based minimally invasive treatments have expanded patients’ therapeutic options, most of which do not call for altering patients’ appearances.
Northwestern Memorial surgeons were the first in the United States to utilize the flexible micro-laser technology that made Villa’s removal a non-invasive success. The surgical system directs CO2 laser energy through the nose to assist with tumor resection. By way of sophisticated two-dimensional and three-dimensional endoscopic visual tools, scalpels and other traditional surgical tools are not needed, allowing for safe breakdown of skull-based tumors with minimal risk of damage to surrounding nerve structures.
Just two days post-surgery, Villa was home with no physical impairments.
“It’s a true team effort and a well-choreographed balance between these specialties,” comments Dr. Kern. “For Mr. Villa, the through-the-nose approach was the best option for a successful resection all while respecting his religious beliefs.”
Northwestern Memorial is among few centers in Illinois to have a neurosurgeon and rhinologist dedicated to skull base surgery. Performing roughly 30 of these procedures annually makes it one of the region’s busiest and largest programs. For more information about the Endoscopic Cranial Base Center and its capabilities, visit www.braintumorinstitute.org.