Bengaluru: City hospital saves 14-year-old boy from rare nasal tumour

Bengaluru: Doctors at HCG Cancer Hospital here successfully treated a 14-year-old suffering from rare nasal tumour.

The 14-year-old Riaz (name changed) from Murudeshwar had dreamed of watching his favourite cricketer and cheer for him during an IPL match. However, his dream seemed short-lived when 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 breathe at the age of 12. It also grew into his brain and eye, wrapping itself around critical structures. He also had recurrent bleeding from his nose and facial disfigurement due to the tumour inside his nose.

Riaz, prior to consulting at HCG Hospital, Bangalore had undergone an open traditional surgery to treat angiofibroma previously at one of the medical colleges in the city to remove the tumour. However, the tumour was not completely excised, resulting in recurrence of the growth, coming back with a vengeance and entered every space in the skull. Riaz's MRI report showed 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 Bengaluru shared, "Angiofibroma is a rare breed of tumour that accounts for only 0.5% of all head and neck tumours. It is predominantly formed of blood vessels and fibrous tissue in varying quantities making this a very vascular tumour and difficult to operate.

These tumours are locally destructive and enter into various crevices of the skull base and reach inside the skull and eye from thereon. Such extensive growth of the tumour makes surgery extremely challenging as tumour is now in close proximity to some very critical structures such as the Internal Carotid Artery (the main artery supplying the anterior and mid part of the brain), optic nerve which carries vision from the eye to the brain, muscles of the eye, cranial nerves and brain itself. Unfortunately, these tumours present in pubescent boys in their early teens."

At HCG, after initial imaging and anaesthetic clearance, Riaz was taken up for surgery and the tumour was removed completely after a 9-hour Endoscopic Skull Base Surgery. The is a form of minimally invasive surgery that is carried out with an endoscope at the level of the skull base and 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 remove 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 endoscopic approach. However, with the invention of the Coblator, surgeons can now cut through the tumor with lesser bleeding, allowing them to resect the tumour into smaller 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 tumor was hugging the carotid around 180 degrees. The tumor 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 tumor 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 a night and the next day he was shifted to the ward for further monitoring. He was discharged without any complications. Today, Riaz is a happy child living out his teens completely tumor free and enjoying his life like a teenager. Since Riaz's family could not afford the surgery, HCG raised money for them through fund-raising organizations and partially funded the surgery.

"We would like to thank Dr Gaurav and all the doctors and staff here at HCG Cancer Hospital for saving my son's life. The hospital helped us in a great way by waving off huge amount of treatment costs and helping us in raising funds for the treatment. We are happy to see our son leading a normal life" said the patient's Father.

Before and after images of the case of a massive Angiofibroma in a 14-year-old which was completely excised with endoscopic skull base surgery and use of Coblator.