Surgeons at the Postgraduate Institute of Medical Education and Research in Chandigarh achieved a remarkable medical feat. They successfully removed a massive 7-centimeter brain tumor from a two-year-old child. This complex procedure utilized advanced endoscopic techniques through the nose.
A Daunting Challenge in Pediatric Neurosurgery
The young patient, hailing from Sonipat in Haryana, presented with severe symptoms. These included a protruding left eyeball, restricted eye movement, noticeable snoring, a visible mass in the left nostril, and excessive eye watering. Medical imaging revealed the true extent of the problem.
CT and MRI scans confirmed a large 7-cm tumor at the anterior skull base. This growth involved critical areas including the nose, sinuses, brain cavity, and the orbit surrounding the eye. A biopsy later identified the mass as a meningioma.
Extreme Rarity in Young Children
Meningiomas of this nature are exceptionally rare in pediatric patients. Skull base tumors are notoriously difficult to operate on, even in adult cases. Performing such a procedure on a two-year-old presented immense risks.
The surgical team faced significant dangers including potential hypothermia, substantial blood loss, and serious fluid disturbances. The only previously documented similar case involved a 12-year-old girl in Spain back in 2020, who required open surgery.
A Collaborative Surgical Triumph
A specialized team assembled to tackle this high-stakes operation. The group was led by neurosurgeon Professor Dhandapani and ENT surgeon Professor Anurag. Their strategy involved a meticulous plan to remove the tumor using an endoscope inserted through the nasal passage.
The initial approach focused on removing as much tumor tissue as safely possible via this minimally invasive route. The surgeons prepared for the possibility of converting to traditional open neurosurgery if necessary.
Innovative Techniques and Precision Execution
The tumor's location demanded innovative surgical methods. It extended down through the nose and spread laterally into the maxillary sinus and orbit. Surgeons performed an expanded endonasal endoscopic procedure.
This required creating additional space by carefully removing a small portion of the anterior cheekbone. The team employed advanced technology including surgical navigation systems, a 45-degree angled endoscope, a coblator for controlled tissue removal, and specially designed long, curved instruments.
These tools allowed them to reach the uppermost part of the tumor, which was adjacent to the brain itself. The growth was highly vascular and involved multiple bones and tight crevices, increasing the complexity.
Successful Outcome Without Open Surgery
In a significant achievement, the surgical team managed to remove the entire tumor using only the endoscopic approach through the nose. This eliminated the need for open brain surgery, a major benefit for the young patient's recovery.
The massive defect in the skull base left by the tumor's removal required careful, multi-layered reconstruction. The entire preparation and surgical procedure spanned approximately nine hours.
Post-operative results have been positive. The child has shown marked improvement following the surgery. A follow-up MRI scan has confirmed the complete and total excision of the tumor, verifying the operation's success.
This case represents a pioneering achievement in pediatric neurosurgery at PGIMER Chandigarh. It demonstrates how collaborative expertise and advanced endoscopic technology can overcome even the most challenging medical conditions in very young patients.
