It is cold and flu season, and that means a lot of us will start suffering symptoms like nasal congestion and sinus headaches.

But sometimes, in teenage boys, those simple symptoms can be a warning sign of something much more serious, an aggressive tumor called JNA.

Removing these tumors once meant invasive, open surgery.

But now, doctors have pioneered a new approach without a single external incision.

For 14-year-old Sam Tessenholtz, the shortest distance from the driveway to the hoop is a quick jump shot. His aim is not always on target, but he is grateful his surgeon's was.

Last April, Dr. Ramzi Younis, a Pediatric Otolaryngologist at the University of Miami Miller School of Medicine, discovered a large tumor against Sam's eye socket, pressing on his brain.

Sam said, "They said it was like a mini tennis ball in my, I don't know what it's called, my nasal cavity or something. Yeah, I didn't want to imagine it."

Instead of cutting directly into Sam's face, Dr. Younis performed an innovative procedure going in through the nose, using a new embolizing material called onyx to cut off the tumor's blood supply.

Dr. Younis said, "We identify the tumor with our scope, go and inject, so instead of going through the main supplying vessel, we go through the tumor, and it goes all over."

Surgeons were able to remove the large tumor through the nose without a single external incision. To Sam's dad, it was nothing short of incredible.

Sam said, "The amazing part is they were able to not disfigure him and take the tennis ball out of his head."

Sam said, "The good news is it's out, and I'm normal, and I can breathe."

He shoots, he scores. Thanks to the successful surgery, Sam is now back in the game.

JNA is a rare type of tumor, most commonly affecting teenage boys.

These tumors are usually benign, and once removed, they do not come back.
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RESEARCH SUMMARY

TOPIC: SAVING SAM FROM A TUMOR CALLED JNA

BACKGROUND: Brain tumors are abnormal growths that occur in the cranium or in the central spinal canal. There are more than 120 types of brain tumors. They can be classified as either benign or malignant. Malignant brain tumors contain cancer cells and are typically more serious and life-threatening. Benign brain tumors are not cancerous, yet they can still be deadly. One type of brain tumor, known as juvenile nasopharyngeal angiofibroma (JNA), typically occurs in teenage boys. Although it is usually benign, JNA tends to bleed and occurs in the nasopharynx.
(SOURCE: www.Braintumor.org)

TREATMENT: Although tumors of the pituitary gland generally are benign and do not spread to the rest of the body, they can create multiple functional problems, including blindness and pressure on the brain. Previously, neurosurgeons had to perform the operation by splitting the facial skeleton or peeling back the scalp and removing the skull on the forehead.

Another option for brain surgery is an endoscopic endonasal approach. This involves removing skull base brain tumors entirely through the nose and sinuses without incisions to the face. During the procedure, surgeons have a good view of surrounding tissue, which helps them to preserve important nerves. The endoscope is inserted through the nose and sinuses to directly reach the tumor. The brain and important nerves are not manipulated during this process. The tumor and surrounding area are brightly lit by the endoscope, which has a tiny camera that sends video images to a large screen. Specially-designed surgical tools are then inserted next to the endoscope to dissect and remove the tumor. (SOURCE: www.brainsurgery.upmc)

ADVANTAGES/DISADVANTAGES: Because the brain is not disturbed, the recovery time after surgery typically is days, instead of weeks or months. Patients are typically able to sail through the procedure with little discomfort and no visible scars. The procedure is also associated with reduced post-operative complications.

Doctors say this operation is less invasive because the incision is made further back in the nasal passages. At the same time, the disadvantage of the endoscope is that surgeons rely on a camera to look at the image. In such a situation, some depth perception is compromised, even with improved cameras with higher definition. Surgeons therefore don't have a three-dimensional image and don't quite get three-dimensional depth. Also, endoscopic brain surgery is not available for all tumors in the brain, just for those at the base. (SOURCE: Cedars-Sinai Maxine Dunitz Neurosurgical Institute)

FOR MORE INFORMATION, PLEASE CONTACT:
Lisa Worley, Director of Media Relations
University of Miami Miller School of Medicine
Miami, FL
(305) 243-5184
Lworley2@med.miami.edu