STORY BYIn the spring, searching for new shrubs for the yard can be exciting for 48-year-old Diane Vasquez. As a gardener, she enjoys nurturing her blossoming plants and lawn.
However, this past year she discovered an unusual type of growth, an orange-sized tumor behind her right eye and attached to the orbit and skull base or the area where the brain sits.
After complaining about blurred vision and headaches, Vasquez went to the hospital for brain scans. That’s when doctors found the large tumor underneath the brain.
“Doctors told me they’d have to cut through my face and skull to remove the tumor,” says Vasquez. “They would have to lift up my skin, cut through the bones of my skull and face, lift my brain and go all the way back to remove the tumor. My family and I were scared, but then we met Dr. Fakhri.”
Samer Fakhri, M.D. is among a select group of otolaryngologists (also known as ear, nose and throat specialists) in the United States specially trained to remove skull base tumors through the nose. The surgery is performed with the use of a tiny endoscope, an instrument only 2.7 mm to 4 mm wide and 20 cm long with straight and angled tips.
“Recent studies have shown that the results of the minimally-invasive endoscopic approach compare favorably to the traditional open techniques for both benign and select malignant tumors,” says Fakhri, director of rhinology and sinonasal surgery in the Department of Otolaryngology-Head and Neck Surgery at The University of Texas Medical School at Houston. “The endoscopic technique provides unsurpassed and magnified visualization. It is also associated with minimal mortality and morbidity, shortened hospital stay and faster recovery time.”
Even though Vasquez’s tumor was located in a complicated area surrounded by the brain, carotid artery and eye, Fakhri determined he could remove the non-cancerous tumor through the nostril using a variety of extremely tiny, flexible and precise endoscopic instruments.
Since the point of entry is through the nostril, no incision is required. The endoscope transmits light and powerful, magnified camera images of the tumor and the surrounding normal tissue on a monitor so the physician can clearly make a full visual assessment. In addition to the monitor, Fakhri uses a computer-aided surgery system, which snaps real time, high-resolution images.
Fakhri removes the tumor in tiny increments to avoid causing a stroke or intracranial hemorrhage. The procedure, which he offers at Memorial Hermann Hospital – Texas Medical Center, takes 8 to 14 hours. The patient can go home within 24 to 48 hours of surgery, enjoy a faster recovery and return to normal activities.
“I completely removed the tumor off the eye and off the area of the carotid artery,” says Fakhri. “Seven to eight years ago, no one would have done this because the tumor was next to very critical areas, and it is something we’re unfamiliar with in terms of uncharted territory. I’m pushing the envelope.”
Vasquez says her vision has slightly improved and she has lost some sense of smell, but neither outcome outweighs undergoing conventional surgery. “It’s a miracle that I don’t have any horrible facial incision,” she says.
Skull base tumors refer to a group of tumors that have a tendency to grow along various regions of the bottom part of the skull. They mostly grow on the inside, but occasionally grow on the outside of the skull. Treating these types of tumor is challenging because this area contains so many blood vessels, nerves and other structures.
Candidates for the endoscopic approach have brain, head and neck tumors extending to the skull base—all benign or non-cancerous.
Fakhri says the chance of reoccurrence is low, but patients are urged to have routine doctor follow-ups especially if there is a family history of cancer. Vasquez’s aggressive tumor could have developed into cancer, and she has a family history of various cancers.
“Post-operative surveillance is another huge advantage of the endoscopic approach because in the office, we can use the endoscope to look for anything suspicious. If we find something, then we go back for a more minor surgery,” says Fakhri.
Vasquez has had a clean bill of health since her surgery last year.
To be a successful gardener, thoughtful planning and careful plant selection are essential. Vasquez says the same attitude applies to planning major surgery. “It’s important to get second opinions. You need to investigate all the options because there may be a better way,” she says.
UPDATED: 6-21-2006
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Dr. Samer Fakhri is director of rhinology and sinonasal surgery in the department of otolaryngology at the UT Medical School.
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Dietary fiber is versatile and talented. It assists in discouraging a long list of woes: constipation, hemorrhoids, heart disease, diabetes, bad cholesterol and certain cancers.
Foods such as apples, berries, oranges, beans, broccoli, bran, multigrain breads and cereals should be added slowly into your diet, followed by an increase in fluid intake. Eventually you want to work up to 4 ½ cups of high fiber foods a day.
Otherwise, you might find yourself feeling more bloated, gassy or experiencing stomach cramps.So, add one high-fiber food at a time about a week apart. Increase your water intake (which includes unsweetened teas, diet sodas, juice) to eight glasses a day to help the fiber move through your system.
