SHARJAH: The ENT and the Neurosurgery team at Zulekha Hospital Sharjah successfully performed a rare combined 12-hour surgery on a patient with Alveolar rhabdomyosarcoma (a rare type of cancer) that involved the left orbit, the left sinonasal cavity, the nasopharynx, the skull base with intracranial extension. The surgery was jointly carried out by Dr. Tamer Mohamed Attia, Consultant Otolaryngology, E.N.T and Dr. Ravi Dadlani, Consultant Neurosurgeon.
According to Dr. Tamer Mohamed Attia, the patient came to Zulekha Hospital, Sharjah in the oncology department with a left orbital swelling and proptosis. Examination and imaging revealed huge mass involving the left orbit, the left sinonasal cavity, the nasopharynx, the skull base with intracranial extension. Biopsy was taken for histopathological purposes and then she had initially been treated with chemotherapy, the orbital part of the tumor was responding very well; however, the nasal and cranial parts were not.
The patient underwent a combined approach surgery where the ENT surgeon entailed endoscopic removal of the entire “macroscopic” tumor from the nasal cavity, all the paranasal sinuses, the nasopharynx and the skull base, while the neurosurgeon has done a craniotomy to remove the intracranial part of the tumor.
Dr Tamer added, “It is impossible to reach “microscopically” tumor free margin as this will necessitate orbital exentration (removal of left orbital content). The plan was to give a chance for the patient to preserve her left eye and leave the tumor margins for a post-operative combined radio and chemotherapy specially that the [intraorbital] part of the tumor was responding very well to chemotherapy prior to the surgery.
From the ENT perspective, the tumor would have continued to grow and invade all the cranial nerves related to anterior and middle skull base, cross midline and impact the right side nose and paranasal sinuses which had already started to happen and the intracranial impact had already happened. Thankfully the distant blood and lymphatic metastasis had not yet occurred. From the neurological perspective, she could have had seizures or strokes with the cancer impacting the brain which could ultimately have been fatal.
From the Neurosurgery point of view, Dr. Ravi Dadlani, Consultant Neurosurgeon said, “She had a large sino-nasal tumor which had eroded the base of the skull and extended into the brain. She had initially been treated with chemotherapy but the tumor had stopped responding to it. The neurosurgery entailed a major surgery (craniotomy- the opening of the skull), approaching the tumor which had impacted the brain, and then repairing the defect in the skull.”
As a malignancy, the risks associated with cancers are generally present. The Patient recovered with no evidence of any residual macroscopic tumor in the nose or PNS on the next day as per the post-operative CT. However, the journey with treatment is still long with post-operative radio and chemotherapy to insure complete eradication of the tumor.
Zulekha Hospital has always stepped forth to accept and manage high-risk, complicated conditions and treated patients with high success rates improving their lifestyles. The hospital is able to do so with the presence of its multidisciplinary team of experts and latest medical infrastructure, which is a key factor while choosing the right healthcare facility in such instances.