Hyderabad-based Citizens Hospital has performed an innovative surgical procedure on a 15 year old boy to remove a rare head and neck tumour.

A team of doctors from Citizens Hospital diagnosed a 15 year boy suffering from severe recurrent nose bleeding and his MRI scan determined the cause of the bleeding was a large tumour in the back of nose and throat. This kind of a tumour is called angio fibroma, a very rare skull-base tumour.

Having learned this, a multidisciplinary team of experts from Rhinology (study of the nose and sinuses), skull-base and brain onco-surgery, as well as neuro radiology and pediatric anesthesia, prescribed CT scan to get a better picture of the tumour. After confirming the tumour as angio fibroma, the team of doctors quickly gave thought to innovative surgical procedure to remove the tumour.

According to the doctors, angio fibroma is very rare tumour and it causes not only nose bleeds but has the potential to bring more critical problems such as bone damage, facial deformity or even blindness.  “In this case the tumour had grown so large that it surrounded the sinus bones and protruded into the boy’s brain cavity in the upper neck. The area is difficult to reach and also contains many important blood vessels and nerves, leaving little margin of error in surgery. The traditional approach requires open surgery, where doctors cut through bones in the face or the skull. Even after successful tumour removal, the risks of this approach are high, and there is also chance for life-long facial damage for the patient. However, combining the skills of several members from our team, we were able to remove it using a minimally-invasive approach,” explained Dr. J. Sashikanth, Senior Consultant and HOD, ENT, Head and Neck Surgery, Citizens Hospital.

With a high degree of collaboration, surgical expertise from different specialties and use of sophisticated medical technology enabled the doctors successfully perform the minimally invasive surgery. “CT scan results of patient’s brain were loaded into our operation theater’s state-of-the-art navigation system, which works like a GPS for the skull and brain. It gives our surgeons very precise information about the complex anatomy of the skull and adds a degree of safety for patients,” said Sashikanth.

Dr. Ateeq Rahman performed an angioplasty in the catheterization lab to locate and temporarily cut the blood supply to the area of the neck and brain to be operated. “With the proper equipment and monitoring, we could do it safe and also minimized bleeding risk, which can be very severe in this type of tumour,” said Ateeq Rahman, Consultant Interventional Neurologist from Citizens Hospital.

The entire complex surgery was performed using endoscopes in about five hours. The patient recovered fast and was discharged in just two days after the surgery with no nasal packing or skin sutures.