The patient Mr. Shankar, a 60-year-old expatriate from Dubai was diagnosed with rapidly growing, infiltrative, highly vascular skull base tumour of the right side. The painful enlargement of the tumour mass was associated with hearing loss, persistent headache, pulsatile tinnitus and unprovoked bleeding from the right ear. He also had progressively worsening difficulty in phonation, acts of swallowing and breathing difficulty too. Mr. Shankar had already visited many specialists in UAE and India too. He decided to have the remedial treatment at a centre of excellence. However, after a thorough discussion with his friends and professional colleagues, he chose MGM as the preferred destination under Prof Dr. Sanjeev Mohanty, Head, Institute of ENT, Head & Neck Surgery.
A thorough clinical examination at MGM Healthcare revealed a reddish mass popping out of the right external auditory canal which bled on touch and was pulsatile in nature. Corroborative radiology findings confirmed the presence of a large highly vascular skull base tumour occupying the region of the right jugular foramen compressing the important cranial nerves which aid in the physiology of speech, swallowing and breathing. A diagnosis of Fisch type D 1 Glomus Jugulare was arrived at based on the clinical and radiological findings. Dr. Mohanty concluded that surgical treatment was the only available option for a complete cure, but was fraught with imminent complications, especially neurological deficits post-operatively. The tumour was adherent to the posterior fossa dura, abutting the cerebellum and other intracranial vital structures nearby.
Dr. Sanjeev Mohanty further explained the case and said, “A multi-disciplinary team approach was adopted and the patient was subjected to pre-operative tumour embolization by the skilful neuro intervention radiology team at MGM. Histopathology further confirmed the nature of this aggressive vascular tumour. Thereafter, a thorough surgical planning was done to avoid intra-operative complications associated with the surgical access to the huge skull base tumour. The important neurovascular structures in the vicinity of the relatively inaccessible anatomical areas were a surgical challenge during the operation. This highly vascular tumour in an advanced stage had close adherence to vital nerves and vessels, connecting the brain through the numerous foramen in the base of skull, which had already begun to show symptoms like bleeding, headache, hearing loss, compromised speech, breathing difficulty and issues in day to day living.”
He further added, “After a thorough surgical planning, a modified Trans temporal-trans mastoid surgical approach with facial nerve transposition and blind sac closure was adopted and the entire tumour mass was excised in toto. The approach required establishing state-of-the-art operating rooms with nerve monitoring strategy and deft surgical approaches, the patient’s skull base tumour was completely removed which was confirmed in the post-operative radiology scans too. Intra-operative bleeding was within controllable limits and all the important cranial nerves were identified and physiological functions preserved after the tumour excision.”
Dr. Ananth Mohan Pai Director - Medical Services, MGM Healthcare shared his views and said “Our experienced team at Institute of ENT, Head & Neck Surgery are here to help the patients manage and treat any disease or condition of the head, neck and ENT. We would like to applaud Mr. Shankar and his family to have courage in this tough times and placing their faith in Dr. Sanjeev and his team. Our aim is to deliver the best of healthcare globally and this will further strengthen people’s trust in our hospital and experts. We wish Mr. Shankar a hale and hearty future.”
The hospital is happy to report that the patient’s stay in hospital was uneventful and was discharged after a week of observation following the marathon surgery. The team of anaesthesiologists ensured a smooth intra-operative period. The surgical outcomes were excellent and post-operative period for the patient was without any complications whatsoever. Mr. Shankar has got a new lease of life after a satisfying stint at MGM. The painful annoying symptoms experienced by the patient have been alleviated post-surgery and he is back on his feet doing his normal activities again.
