PGI performs groundbreaking brain tumour surgery on 2-year-old girl
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Chandigarh: A team of neurosurgeons at PGI successfully performed a groundbreaking brain surgery on a two-year-old girl from Amroha, Uttar Pradesh, who was losing her vision. The doctors removed a giant 4.5 cm brain tumour through the child's nose, a procedure considered one of the most challenging in paediatric neurosurgery.
Dr S S Dhandapani, who led the team, previously published the first report in the world on endonasal surgery for craniopharyngioma—surgery for the removal of a brain tumour of size 3.4 cm at 16 months of age. "But tumours larger than 4 cm, called giant tumours, have never undergone surgery through the nose at 2 years of age, except once before at Stanford," said Dr Dhandapani.
The young patient arrived at the hospital with significant vision loss in both eyes and hormonal deficiencies.
An MRI scan revealed a massive tumour, a craniopharyngioma, lodged deep at the base of her brain, close to critical structures like the optic nerves and hypothalamus.
While the standard treatment for such tumours involves opening the skull, this approach was too risky for a child so young. The surgical team opted for a highly advanced endoscopic endonasal surgery — a procedure where surgeons navigate through the nasal passages to reach the tumour.
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This approach avoids cutting into the skull and retracting the brain, significantly reducing recovery time and potential damage.
However, performing this surgery on a small child less than 4 years of age is challenging. "The child's nasal corridors are tiny, the bones at the skull base are still immature, and vital blood vessels are in close proximity. We had to make holes close to the carotid artery—major blood vessels in the neck that supply oxygenated blood to the brain, face, and neck," said the neurosurgeon.
Over a gruelling six-hour operation, the team, which included ENT surgeon Dr Rijuneeta, utilised a thin, high-definition endoscope and computer navigation to meticulously create a path to the tumour. With a combination of specialised micro-instruments and extensive drilling of immature bones, they carefully dissected the tumour from the delicate neural structures and removed it piece by piece through the nose.
Just 10 days later, a CT scan confirmed the near-total removal of the tumour, and the young girl is now stable. "But we have to wait for the restoration of her vision, which was lost before the surgery due to the delay in coming to us," said Dhandapani.
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