Indian-American surgeon helps remove golf ball-sized brain tumour through nose 

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An Indian-American army surgeon played a key role in an innovative minimally invasive procedure to remove a golf ball-sized brain tumour through a patient’s nose, helping avoid open brain surgery.

Major Jagatkumar Patel, an anterior skull base surgeon at the Walter Reed National Military Medical Centre near Washington, worked with neurosurgeon Lt Col Charles Miller to perform the rare surgical procedure on Marine Corps Staff Sergeant Andy Archer, who had lived with the tumour for 15 years.

The procedure required highly synchronised collaboration between the two experts, the US Department of Defence said in a statement.

The benign tumour, measuring about 4.4 cm, was located in front of the pituitary gland of Archer and was pressing against his optic nerve.

According to the Defence Department, Patel developed a plan to navigate the patient’s complex nasal anatomy and create a clear surgical pathway to remove the golf ball-sized tumour through the nasal passages using an endoscope.

“Today, if a tumour is the appropriate size and location, open surgery just isn’t necessary. Through the nose, we get the best access and the best chance of complete removal,” Patel was quoted as saying in the statement.

After Patel established the surgical pathway, he used an endoscopic camera to provide high-definition, close-up visualisation on a surgical monitor. This allowed Miller the crucial two-handed freedom to dissect and extract the tumour safely.

“If he needs to get to critical structures, I can drive the camera closer, so he has perfect visualisation,” Patel noted.

The team successfully removed more than 99 per cent of the tumour earlier this month.

Still, a microscopic fraction of the tumour remained wrapped tightly behind Archer’s optic nerve, which, if removed, carried major risks, the statement said.

“You must ask, ‘Is it worth giving the patient a stroke or permanently changing their perfect vision just to get that last millimetre?'” Patel said.

The surgeons said they were confident the remaining fragment was highly unlikely to regrow.

To complete the surgery, the team reconstructed the skull base using a small tissue graft taken from Archer’s leg to seal the surgical site.

According to the Defence Department, Archer showed no visible signs of having undergone major brain surgery just two days after the operation.

His vision had already begun improving, while his post-operative symptoms were limited to expected headaches and soreness in the leg from where the graft was taken.

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