PGIMER conducts nasal endoscopic surgery on youngest-ever patient

Chandigarh institute’s skull-base surgeons have successfully removed a large brain tumour through the nose in a 16-month-old

The Chandigarh-based premier tertiary care hospital, the Postgraduate Institute of Medical Education and Research (PGIMER), has said that its team of endoscopic skull-base surgeons have successfully removed a large brain tumour (craniopharyngioma) through the nose on the youngest-ever patient for such a surgery in the world.

An official statement from PGIMER said the operation was conducted by team of surgeons, including Dr. Dhandapani S.S. and Dr. Sushant from the Department of Neurosurgery, and Dr. Rijuneeta from the Department of ENT.

“A girl child of one year and four months from Uttarakhand was referred to PGIMER with complaints of loss of vision. The child was normal and playful following visual stimuli a few months back. For the last 20 days, the mother noticed that the child was not following anything shown to her. The child’s MRI revealed a calcified brain tumour at the base of the skull suggestive of craniopharyngioma of size three cm, large for a child of one year, close to critical neural structures such as optic nerves and hypothalamus,” it said.

“These tumours are usually operated upon through open surgery, and the remaining part is treated with radiation therapy. Over the last few years, such tumours are being removed through the nose endoscopically by neurosurgeons teaming with ENT surgeons among patients older than six years. However, endoscopic removal through the nose is highly challenging in small children because of small nostrils, immature bones at the skull base, and proximity to crucial blood vessels. The youngest child reported to date having undergone endoscopic surgery through the nose for such tumours was two years old, operated in 2019 at Stanford, USA,” it added.

The statement added that despite the enormous challenge, Dr. Dhandapani chose the endonasal corridor, as skull opening and brain retraction are avoided if the operation is conducted through the nose. “The team studied the child elaborately using CT angiography navigation and planned for endoscopy. A thin high-definition endoscope, micro-instruments, and laryngeal coblator were used during the initial steps. Reaching up to the tumour was difficult, as the bones and sinuses were immature. The typical air sinus, which usually gives a corridor to reach up to the tumour base, was absent in this child. The nasal stage was performed by Dr. Rijuneeta, while the skull base part was completed by Dr. Dhandapani and Dr. Sushant,” it said.

“After a six hours long surgery, the child was kept in the ICU and recovered very well. After 10 days of surgery, the child is doing great with improved vision and no complications, with a CT scan showing almost complete removal,” added the statement.

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