PGIMER Surgeons Achieve Historic Pediatric Tumor Removal Through Nose
Doctors at the Postgraduate Institute of Medical Education and Research in Chandigarh have accomplished a remarkable surgical feat. They successfully removed what they believe is the world's largest skull base tumor from a two-year-old child. The entire procedure was performed through the nose using endoscopic techniques.
Rare and Complex Pediatric Case
The young patient from Sonipat arrived at PGIMER with concerning symptoms. The child had a protruding left eye, limited eye movement, persistent snoring, excessive tearing, and a visible mass in the left nostril. Medical imaging revealed the shocking extent of the problem.
CT and MRI scans showed a massive 7-centimeter tumor at the anterior skull base. This growth extended into multiple critical areas including the nasal cavity, paranasal sinuses, the brain itself, and the orbit surrounding the eye. A biopsy confirmed the diagnosis as meningioma, a type of tumor exceptionally rare in children this young.
Doctors emphasized the extreme rarity of such tumors in toddlers. They described these growths as among the most challenging skull base lesions to treat in any patient, let alone a two-year-old.
High-Risk Surgical Challenge
The medical team faced multiple serious concerns before the operation. The child's tender age presented significant anesthesia risks. The tumor's enormous size and delicate location near vital brain structures created additional dangers.
Major potential complications included:
- Substantial blood loss during surgery
- Dangerous drops in body temperature (hypothermia)
- Critical fluid imbalances
- Damage to surrounding brain tissue
Given these risks, PGIMER assembled a specialized multidisciplinary team. This group included experts from neurosurgery, ENT, and neuroanesthesia working together to plan the complex procedure.
Innovative Surgical Approach
The surgical team, led by Professor Dhandapani from neurosurgery and Professor Anurag from ENT, developed an innovative strategy. They decided against traditional open skull surgery. Instead, they chose an expanded endonasal endoscopic approach.
Surgeons created additional working space by carefully shaving part of the anterior cheekbone. They then employed advanced technologies to navigate the delicate anatomy:
- Surgical navigation systems for precise tumor localization
- Angled endoscopes to visualize hidden areas
- A coblator for controlled tissue removal
- Customized long instruments to reach deep tumor portions
The intricate operation lasted approximately nine hours. Despite the tumor's extensive vascular network and invasion into multiple bone compartments, the medical team achieved complete removal through the nasal route alone.
Successful Outcome and Recovery
Following tumor excision, surgeons reconstructed the skull base defect using a multilayer closure technique. This careful reconstruction prevents cerebrospinal fluid leaks and protects the brain.
The young patient showed marked improvement after surgery. Follow-up MRI scans confirmed what the surgical team had hoped for - total excision of the massive tumor with no residual growth.
This groundbreaking case demonstrates how advanced endoscopic techniques can treat even the most challenging pediatric skull base tumors. The successful outcome offers hope for other children facing similar rare conditions. The PGIMER team's achievement pushes the boundaries of what's possible in minimally invasive pediatric neurosurgery.
