University of Texas Southwestern Medical Center (UTSW) in Dallas has announced that a team of skull base surgeons is helping to pioneer a new minimally invasive procedure that extracts vertigo-inducing tumors from the inner ear without requiring patients to undergo a more invasive standard surgery that involves removing a large piece of skull.
UTSW Head and Neck Surgeons have removed acoustic neuromas, or tumors, through small incisions in the ear canals of two patients using an endoscope. These are believed to be the first such operations done in the US since the method was recently developed in Italy. No other US cases have been reported in the medical literature.
UTSW reports that more study is needed to evaluate the surgery outcomes compared with more standard procedures for acoustic neuroma removal, but benefits may include less pain and a quicker recovery time as compared to more invasive surgeries.
Brandon Isaacson, MD, associate professor of Otolaryngology – Head and Neck Surgery, who performed the surgeries, explains that acoustic neuroma is a rare benign tumor involving the hearing and balance nerve that can cause severe hearing loss, dizziness, or vertigo, affecting fewer than 4 out of every 100,000 people. Untreated tumors can grow, causing deafness in the affected ear and, in rare cases, can be fatal. Slow-growing acoustic neuromas are typically managed through periodic monitoring with MRI, radiation or surgery that has traditionally involved removing large amounts of bone from the skull around the ear.
The new minimally invasive endoscopic procedure could offer an early treatment option for patients who have growing tumors still small enough to extract through the ear canal. “The bigger [a tumor] gets, the harder it is to treat,” said Dr Isaacson, co-director of UT Southwestern’s Comprehensive Skull Base Surgery Program, part of UT Southwestern’s Peter O’Donnell Jr. Brain Institute.
One of his patients, waited seven months to seek treatment after first experiencing muffled hearing in her left ear. Once her symptoms escalated, she sought help from Dr Isaacson, who diagnosed the tumor. By that time, her ear had lost all function and could not be fixed. UTSW says that by opting for the endoscopic procedure, this patient avoided the radiation treatment she feared and was released from the hospital in two days – less than half the time normally required with traditional surgery.
This patient is still recovering from lingering side effects of dizziness, but expects to miss only about a month of work and isn’t feeling overwhelmed by pain. “To me, anything that is less invasive is better,” said the working mother of three.
Dr Isaacson collaborates with Samuel Barnett, MD, associate professor of Neurological Surgery and Otolarynology, to perform the surgery using a camera attached to an endoscope consisting of a narrow, metal tube filled with fiber optic cables that transmit images to a TV screen. The surgeons make a small incision in the patient’s ear canal and use the endoscope to help locate the tumor for removal.
The surgeons have been spearheading several endoscopy techniques for minimally invasive approaches to traditional open surgeries, such as fixing ear-drum holes and removing other types of rare tumors.
UT Southwestern reports that it has been pioneering opportunities for minimally invasive surgery in several other areas, including efforts to develop magnetically controlled surgical instruments to reduce the number of entry ports into abdominal cavities. UT Southwestern integrates biomedical research with clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of almost 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about 80 specialties to more than 100,000 hospitalized patients and oversee approximately 2.2 million outpatient visits a year.
Image credits: Douglas Preuss, Children’s Medical Center; UT Southwestern Medical Center