Physician Update - A New Window to the Skull Base
A New Window to the Skull Base
Date: June 15, 2012
When Jodi Elkin came to head and neck surgeon Kofi Boahene, it was after her home doctors discovered a skull base growth—her second brain tumor in a year. No doubt the new one needed resection, but Boahene, who also specializes in facial plastic and reconstructive surgery, wanted to spare the college student a second traumatic procedure.
“For skull base, there’s typically a six-hour operation in which you have to cut bones, potentially causing disfiguring scars and putting facial nerves at risk,” he says. The procedure often brings long hospital stays and longer home recovery, a strain on both patient and health care.
Boahene, however, had an inspiration—one that came as he mulled over the site of Elkin’s tumor. “I looked at the ‘window’ that already exists in the skull behind the molars, above the jawbone and below the cheekbone,” he explains, “and realized I was seeing a new access for this kind of surgery.”
Boahene and colleagues pioneered the transvestibular paramandibular approach with Elkin last year. Instead of the expected six hours, surgery was over in two. Elkin left the hospital the next day, later returning to college with no visible evidence of the operation, thanks to incisions on the inside of her cheek.
Now the team has repeated the approach multiple times, convinced that the new procedure is far less complicated and that it offers a fine visualization of the skull base. Moreover, it’s versatile, Boahene says. Besides tumor resections, the technique could ease skull base biopsies or uncomplicate injections of skull base nerves for intractable pain. A few caveats: the procedure isn’t an option for very large skull base tumors or neoplasms that wrap around blood vessels. There, traditional skull base surgery is best.
Still, Boahene says he marks the approach as an unusually useful newcomer to Hopkins’ list of surgical firsts.
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