B’luru docs treat 14-year-old with rare nasal tumour

NT Correspondent

Fourteen-year old Riaz (name  changed) from Murudeshwar dreamed of watching his favourite cricketers and cheering them in IPL matches. This wasn’t to be as he was diagnosed with Angiofibroma, a rare type of nasal tumour or a massive nasal mass that obstructs the airway, thus making it difficult for him to even breathe at the tender age of 12. It then began to grow, into his brain and eye, wrapping itself around critical structures. He began to have recurring bleeding from the nose and facial disfigurement due to the tumour inside his nose.

Riaz, prior to consulting at HCG Hospital, Bengaluru, had undergone a traditional open surgery to remove the tumour at a medical college in the city. However, the tumour was not completely excised, resulting in recurrence of the growth. This time, it came back with a vengeance and entered every space in the skull. Riaz’s MRI report revealed that the tumour had occupied almost half of his skull.

Explaining the rarity of Riaz’s condition, Dr Gaurav Medikeri, surgical oncologist, HCG Cancer Hospital said, “Angiofibroma is a rare breed of tumour that accounts for only 0.5 per cent of all head and neck tumours. It is predominantly formed of blood vessels and fibrous tissues in varying quantities making it a very vascular tumour and difficult to operate upon. These tumours are locally destructive and enter various crevices of the skull base and reach inside the skull and eyes from thereon. Such extensive growth of the tumour makes surgery extremely challenging as the tumour is now in close proximity to some very critical structures such as the Internal Carotid Artery (the main artery supplying to the anterior and mid part of the brain), optic nerve that carries vision from the eye to the brain, muscles of the eye, cranial nerves and the brain itself. Unfortunately, these tumours show up in pubescent boys in their early teens.”

At HCG, after initial imaging and anaesthetic clearance, Riaz was taken for surgery and the tumour was removed completely after a nine-hour Endoscopic Skull Base Surgery. It is a form of minimally invasive surgery that is carried out with an endoscope at the level of the skull base. It was performed without a single cut made on the patient’s face to remove the tumour. The doctors used innovative instruments such as the Coblator to prevent excessive bleeding and removed the tumour completely. The challenge during the surgery was the presence of the tumour at the nostril level itself. Earlier, this would have been a contraindication for an endoscopic approach. However, with the invention of the Coblator, surgeons can now cut through the tumour with lesser bleeding, allowing them to resect the tumour in small segments and removing each segment separately. This particular tumour had been divided into seven segments.

Explaining Endoscopic Skull Base Surgery, Dr Gaurav Medikeri further added, “The most critical part of the dissection was at the level of the right cavernous carotid artery where the tumour was hugging the carotid by almost 180 degrees. The tumour was peeled off this huge vessel, slowly and gently taking care not to tear the vessel at any point, since that would lead to catastrophic bleeding and stroke or possible death. The other area, which is critical, is the dissection of the tumour inside the eye, which again should be done slowly. Endoscopic surgery has changed the game these days. Patients have to stay in hospital for shorter periods, lesser or almost no ICU stay and the morbidity is negligible to say the least.”

Riaz was in the ICU for observation for the night and the next day he was shifted to a ward for further monitoring. He was discharged without any complications. Today, Riaz is a happy child living out his teens completely tumour-free and enjoying life. Since Riaz’s family could not afford the surgery, HCG raised money for them through fundraising organisations and partially funded the surgery itself.

“We would like to thank Dr Gaurav and all the doctors and staff at HCG Cancer Hospital for saving my son’s life. The hospital helped us in a great way by waving off the huge amount of treatment costs and also helped raise funds for the treatment. We are happy to see our son leading a normal life today,” said the patient’s father.