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HeadWay - After a harrowing surgery, incredible success
HeadWay Spring 2012
After a harrowing surgery, incredible success
Date: May 25, 2012
For their patient’s massive tumor in a sensitive location, Jeremy Richmon (standing) and John Carey had to develop a unique approach to avoid serious functional deficits.
photo by Keith Weller
In late 2010, at the urging of his then-fianceé, Gregory Daily visited his family doctor to get checked out for snoring. He left with a problem far worse than a lousy night’s sleep. When his doctor peered into the back of Daily’s throat, he noticed that structures there appeared as if they’d been shoved to the left.
A CT scan revealed a softball-size skull-base paraganglioma wrapped precariously around his carotid artery and other crucial structures, including additional blood vessels and important nerves, and pressing against his pharynx, dangerously narrowing his airway.
“It’s one of those cases where everyone looks at the scan and gulps,” Carey says. Complicating the scenario further, he explains, additional examinations showed that the tumor was highly vascularized, making removing it especially dangerous.
But Richmon, Carey and their colleagues all agreed that the tumor had to be removed. It would only continue to grow, eventually leading to a host of deficits.
The doctors scheduled Daily’s surgery, then discovered weeks later that he was a candidate for a new nuclear medicine trial that had the potential to shrink his tumor. Daily underwent two treatments with radioactive iodine, but the therapy didn’t have a significant effect.
Returning to the original plan, Richmon, Carey and their colleagues, including Hopkins neurosurgeon Gary Gallia, prepared their patient for surgery in October 2011.
“There’s only a handful of cases that keep me up at night, and this was one of them,” Richmon recalls. Because of the tumor’s location, size and vascularization, removing it had enormous risks, including the potential for stroke, facial paralysis, breathing and eating problems necessitating permanent tracheostomy and feeding tubes, and excessive blood loss.
After developing a comprehensive plan for Daily’s surgery, the team commenced work on Oct. 7. They took a tag-team approach, with Richmon, Carey and their colleagues trading off repeatedly over the course of the resection.
Twenty-six hours later, Daily’s surgery was finished, but his journey to recovery had just begun. Over the next few months, he received an injection laryngoplasty from Richmon, met with physical and occupational therapists to work on swallowing and other basic skills, and had numerous follow-ups with both surgeons and other care providers.
Today, Daily is enjoying life with his new wife, whom he married in April. The 27-year-old has had none of the serious functional deficits that his doctors were so concerned about. “Besides my scar,” Daily says, “there’s really nothing you could see if you looked at me that would tell you what I’ve been through.”
For Richmon and Carey, seeing Daily’s success is a reminder of the incredible promise of medicine. “It reminds me of why we all go into this profession,” Richmon says. “It’s such a great joy and reward to have patients like this do so well.”