First-of-its-kind Minimally Invasive Skull Base Tumour Through Mouth Successfully Performed On 67-Year-Old Woman

Dr Narayana Subramaniam, Director – Head & Neck Surgery, Oncology and Director – Clinical Innovation, SPARSH Hospital, Bangalore.

In a ground-breaking surgical achievement, a 67-year-old woman from Bangalore has successfully undergone an innovative and pioneering procedure to remove a tumour from her skull base though mouth. Mangala (name changed) was presented with a 2×2 cm tumour behind her upper jaw. What makes the procedure unique was the location which was a challenging one; it was behind the upper jaw in the parapharyngeal space, a narrow corridor that extends from the upper neck to the skull base. It was in proximity (around 1.2 cm) from the internal carotid artery, the main artery that supplies blood to the brain, as well as multiple cranial nerves that control tongue movement, voice and shoulder function.

 Conventional approaches would involve splitting the lower jawbone or creating a controlled fracture of the upper jawbone to move it out of the way for access. The concern with endoscopic removal was that it would require removal in pieces and not whole, leading to spillage and a higher chance of recurrence. Robotic surgery was also not considered as conventional robotic surgery does not involve drilling away of bone, which was required to provide access in this case. In order to reduce the trauma associated with surgery and recovery, the team of expert doctors at SPARSH Hospital used a novel approach, where the entire approach was through the mouth, and the access was by removing the posterior aspect of the upper jaw bone and displacing the muscles to create a corridor to completely remove the tumour. 

Speaking on the success of this innovative surgery, Dr Narayana Subramaniam, Director – Head & Neck Surgery, Oncology and Director – Clinical Innovation, SPARSH Hospital, Bangalore says, This was a novel approach for a novel tumour. By devising this approach, we were able to access this tumour and remove it completely without splitting the upper or lower jaw and avoiding any incisions on the face. She also had a smooth recovery with no weakness of any major cranial nerves or intra-operative bleeding, which is common with conventional approaches. Complex head and neck surgery requires a patient-centric approach, extensive expertise and lots of teamwork, which enables excellent outcomes.

 In this remarkable surgical accomplishment, the two-and-a-half-hour procedure ended in a smooth recovery for Mangala. SPARSH Hospital takes pride in this exceptional surgical achievement, showcasing its commitment to innovative and patient-centric care. This phenomenal success highlights the dedication to advancing healthcare through progressive solutions for patients dealing with complicated medical challenges.