When a woman in her early 40s began experiencing double vision followed by problems swallowing, she visited an ENT physician who found that one of her vocal cords was becoming paralyzed, as was the musculature in the back of her mouth, which explained why she was choking on her food. It wasn’t until she made an appointment at Mayfield Brain & Spine that she learned the root of all her problems — a 6.5-cm tumor was growing off the base of her skull, pushing on her brain stem and cranial nerves.
She went to the right place. Mayfield has a strong tradition as a skull base center, having performed the vast majority of skull base tumor surgeries in Cincinnati for decades. In fact, Mayfield has the only two fellowship-trained skull base surgeons in the city.
Skull base surgery is a specialized type of neurosurgery that requires additional training beyond the typical six to seven years of neurosurgical training because it’s harder to get to the deep places of the brain.
“These tumors and other lesions located in the base of the skull are intimately associated with cranial nerves and vital brain functions, and we have to figure out how to get in and out of those places of the brain,” says Dr. Vincent DiNapoli, a Mayfield neurosurgeon and director of the Brain Tumor Center at The Jewish Hospital.
Learning from master skull base surgeons on how to do these techniques is essential when dealing with millimeters of space during surgery. Dr. DiNapoli notes that tumors are deep within the center of the head, so surgeons must fashion approaches through the bone.
“You want to take away bone so you can open a corridor to get in without retracting or pushing aside brain tissues, which could cause deficits,” says Dr.DiNapoli. “If you injure arteries, you can cause strokes. If you injure cranial nerves, you can cause a host of neurologic deficits, including double vision, imbalance, problems swallowing or walking, or loss of sight and smell.”
Administrator Dr. DiNapoli and neurosurgeon Yair Gozal, M.D., Ph.D., work together to prepare for cases and coordinate the best options for the approach, the resection of the tumor and the reconstruction afterward.
“Patients often focus only on getting the tumor out. As skull base neurosurgeons, we have to consider the best way to get to the tumor and how to close after we’ve drilled away bone and gotten the tumor out,” says Dr. Gozal. “Dr. DiNapoli and I, along with other sub-specialists on our team, make sure we have a proper plan in place for each tumor we work on.”
Having two fellowship-trained neurosurgeons working together and swapping out to take short breaks minimizes the fatigue on each surgeon, which is essential, considering that these operations can last several hours.
“These complex cases require total attention. After hours of focus, it’s hard to continue to provide that,” says Dr. Gozal. “Dr. DiNapoli and I can trade off knowing that the quality of care is not hampered.”
Specialists in the Skull Base Surgery Program utilize state-of-the-art technology and equipment, including intraoperative monitoring, specialized neuro-anesthetic techniques and neuronavigation. For instance, they adopted minimally invasive techniques such as using small endoscopes, which provides better visualization. The program is also the only skull base program in the region to have Gamma Knife stereotactic radiosurgery for those cases that require radiation. Plus, they have an intraoperative CT machine that works like a 3-D GPS system to guide the surgeons during surgery.
“That’s a huge advantage because it allows us to create more tailored openings, and we can target the lesion very precisely,” says Dr. DiNapoli.
Now one year post-surgery, the patient with the 6.5 cm tumor has fully recovered and all her functions have returned to normal. That’s due, in large part, to the quality of care she received, and one of the reasons the Mayfield team, along with other physicians of the Jewish Hospital Brain Tumor Center, were recently recognized as one of 16 programs nationally in the North American Skull Base Society Honor Roll.
“A lot of places have a hard time recruiting skull base specialists because of the extensive training that’s required,” says Dr. Gozal. “The fact that we have two has really helped our patient outcomes.”
Mayfield Brain & Spine has four locations throughout Greater Cincinnati and Northern Kentucky. For more information or to schedule an appointment, call 513.221.1100 or visit www.MayfieldClinic.com