An eye-opening new surgery
Date: November 30, 2010
When Kofi Boahene met a 15-month-old child who needed a biopsy on a skull-base tumor, he knew there had to be a better way other than the traditional method.
The standard way to access the base of the brain has been the same for decades: Make an incision from ear to ear, remove bone, lift the brain and head for the skull base. Some minimally invasive techniques that take advantage of natural orifices such as the nose have helped to reduce patients’ scars and speed healing. However, these newer techniques aren’t an option for every patient, including this toddler.
Boahene, a facial plastic and reconstructive surgeon, and his colleagues came up with a novel idea: Why not reach the brain through the eyelid?
The surgeons developed a plan that involved making an incision on the natural crease of the eyelid. Boahene and his colleagues went through that incision, removed bone above the brow and were able to easily access the tumor at the child’s skull base. “It was a nice surprise to find how much exposure you could get through the eyelid, even in such a tiny child,” he says.
That initial surgery was a success. Since then, Boahene and his team have performed several other operations through the eyelid to obtain specimens for biopsies, to remove sinus and brain tumors, or to fix cerebrospinal fluid leaks.
This new technique comes with a host of advantages, he says. For example, in patients who have had the traditional surgery multiple times, the eyelid approach offers a new way to access the same area without going through scar tissue. It’s also useful for reaching tumors that are away from the midline, an area that is often inaccessible in surgeries that go through the nose. It is also particularly useful for removing the brain portion of sinus tumors that grow cross the skull base. Additionally, the new technique shortens patients’ hospital stays, often to three days or fewer, depending on their pathology.
But the benefit that often matters the most to patients is the lack of a visible scar. Just before the surgery takes place, Boahene uses a marking pen to plot out where the incision will be. “The goal is that we won’t see the marker when the patient’s eyes are open,” he says. If the marker isn’t visible, he explains, the scar won’t be visible either.
Although the procedure has mostly been used for smaller lesions or cerebrospinal fluid leaks in the anterior or midline, Boahene and his team soon expect to use it for larger tumors, aneurysms and other concerns. They also plan to incorporate the surgical robot into their technique. “We are really pushing the envelope with this,” Boahene says.
To refer a patient, call 410-502-2145.