How your nose is helping in the fight against cancer

A few months ago, just walking his dog would have been too much for Robert Matthews.

"I wasn't stable walking. My speech was slurred,” Robert said. “I used to always have these migraines, and they were bad."

Tests showed Robert had a large, non-cancerous tumor pressing on his brain.

"When you first find out that you have any kind of foreign thing inside your head, you want it gone," he said.

Robert's doctor said he needed a craniotomy - which involves making a large incision to open the skull and going deep in the brain to remove the tumor. But then Cleveland Clinic surgeons told him about a new option.

"Essentially, we use the nose as a channel or a pathway to get up to the brain," doctor Raj Sindwani, otolaryngologist, Cleveland Clinic, explained.

Two surgeons enter through the patient's nose and cut a tiny opening in the brain covering. They use special instruments to remove the lesion through the small hole.

"These surgeries are like a finely orchestrated dance,” doctor Pablo Recinos, neurosurgeon, Cleveland Clinic, said. “They require two surgeons to be operating with four hands through the nose."

Instead of a cut from ear to ear, the internal incision is just two centimeters. Surgeons don't have to disrupt the frontal lobes in the brain. That means less pain and a faster recovery - four to six weeks instead of three to six months.

Robert hasn't had any symptoms since his surgery. Now he can enjoy his pets - without any pain.

Not everyone with a brain tumor is a candidate for this procedure.

The patient's tumor has to be at the base of the skull.

Although this surgery is less risky than a craniotomy, there is a chance patients could lose their sense of smell or experience a decreased sense of smell.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: Brain Surgery through the Nose
REPORT: 3818

BRAIN TUMORS: When cells become old, they die off and get replaced with new cells. Sometimes, something disrupts this process and the old cells that your body doesn't need any more continue to grow until they develop into a mass of tissue. This mass of tissue is known as a tumor. Primary brain tumors, meaning they start in the brain, can either be malignant or benign. A tumor arriving from the brain's meninges is called a meningioma. While benign tumors are non-cancerous, malignant tumors are cancers that grow and spread aggressively throughout the rest of the brain. Though benign tumors are generally non-life-threatening, any tumor that develops in the brain can be a major health risk, as it's putting too much pressure on the tissue inside the skull. Metastatic tumors are tumors found in the brain that formed elsewhere in the body. (Source: http://www.webmd.com/cancer/brain-cancer/brain-tumors-in-adults)
TREATMENT: Brain tumors are treated with surgery, radiation therapy and chemotherapy. Treatment for brain tumors is based on several different factors including age, medical history and the tumor's size and location. If surgery cannot be performed, doctors may treat the tumor with radiation from X-rays to destroy tumor cells or slow tumor growth. After each treatment, long-term plans are developed to monitor for any possible future tumor formation or growth. (Source: http://www.braintumor.org/brain-tumor-information/treatment-options/)
NEW TECHNOLOGY: Brain surgery is an extremely risky procedure and can be very painful for the patient. There's now a new option to perform brain surgery that uses the nose to get to the brain. Unlike the standard craniotomy, a risky procedure involving a large incision through the skull to access the brain, transnasal endoscopic skull-base surgery is a completely new procedure that's less invasive and has a shorter recovery time. Surgeons access the brain through the nostrils, remove the tumor and repair and damaged tissue. To be a candidate for the procedure the patient's tumor must be at the base of the skull. (Source: http://cleveland.cbslocal.com/2014/05/29/surgeons-performing-brain-surgery-through-the-nose-2/)


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