Hard search for less invasive brain surgery leads to eyelid

Doctor after doctor said removing the tumor causing Pamela Shavaun Scott’s unrelenting headaches would require cutting open the top of her skull and pushing aside her brain. Then one offered a startling shortcut – operating through her eyelid.

The idea: Make a small incision right in the crease and sneak past the eyeball into the hard-to-reach center of the head.

“The nice thing about it is, we have to saw off much less of your head,” is how Dr. S. Tonya Stefko of the University of Pittsburgh Medical Center explains it.

Less invasive brain surgery isn’t common but surgeons are working out different ways to get to tumors, aneurysms and other problems without as much trauma in hopes that patients recover faster. But Scott’s experience shows how difficult it can be for patients to learn about alternative options like the eyelid approach – performed by a small number of highly specialized surgical teams – or even to know what to ask.

Scott knew that major medical centers often offer second-opinion consultations for long-distance patients, and started hunting – aided when her husband used a 3D printer to create a life-size model of her skull with her tumor, a meningioma growing behind her left eye, for surgeons to examine.

“The sad thing is that people don’t know there are other options than what their small-town doctor is telling them,” said Scott, 56, who traveled from her home in Morro Bay, California, to Pittsburgh for the surgery. “I feel like a walking miracle.”

Reaching that spot above and behind the eyes, the underside of the brain, is a challenge. Traditional surgery means a large opening in the skull to give doctors plenty of room to maneuver. But they must move painstakingly past sections of healthy brain, and Scott was warned that because her tumor was in such a tough location, vision or even cognitive damage was a risk of that top-down surgery.

Sometimes, surgeons can snake their tools through the nasal passages instead, a straighter shot through a natural opening.

Now the eye is offering some paths into this difficult region, too.

Think of the eye socket like an ice cream cone, with the tip pointing back toward the brain’s center, said Dr. Paul Gardner, director of UPMC’s Center for Skull Base Surgery. Entering through the eyelid crease, surgeons can follow that cone to just the right spot to access the brain – removing a bit of bone about the size of two postage stamps from the inside.

Entering the socket at a different angle, doctors also can make a cut in the crow’s feet at the corner of the eye. Or they can hide an incision in the eyebrow, making a small hole in the skull just above the eye.

Dr. Robert Harbaugh, president of the American Association of Neurological Surgeons, cautioned that transorbital approaches haven’t been formally studied to compare ultimate outcomes, including safety, to traditional open surgery.

“This is worth exploring,” he said. But, “because it’s new doesn’t mean it’s necessarily better.”

The surgery is only for carefully selected patients, stressed Dr Alfredo Quinones-Hinojosa, a John Hopkins University neurosurgeon who co-authored one of the first medical journal reports on the eyelid method a few years ago.

Tumors can’t be too big. No important nerves can be in the way; he also turns away people with large sinuses, to be sure there’s room to get by. He calls infection the main risk.

And it can only be done by a specialized team with experience in both the eye and the brain, added Gardner, who will present some of Pittsburgh’s cases at a medical meeting next month. Stefko, UPMC’s director of orbital and oculoplastic surgery, has the job of protecting the eyeball, making the corridor for the neurosurgeons to work.

Those kinds of multidisciplinary teams are rare, limiting wider adoption of these techniques, said Quinones-Hinojosa.

“You really have to learn how to be co-captains. Medicine and surgery hasn’t been, traditionally, like that,” he said.

For California’s Scott, it took a few hours longer to remove her meningioma – a benign tumor that started in the brain’s protective covering and grew into the bone and near her optic nerve – through the small opening. But she awoke with essentially a black eye, and was back at work in her psychotherapy practice in two weeks, wearing sunglasses.

In Indianapolis, dentist Deborah Boyer underwent a similar months-long search to treat a meningioma growing around critical nerves and blood vessels, threatening her vision and motor function. She wanted both a brain and an eye specialist. So she read medical journals online and hunted designated “centers of excellence.”

Pittsburgh’s Gardner initially planned to cut through the side of her skull, a smaller operation than other doctors offered, but later decided the corner of her eye offered a good path. Boyer said it took twice as long as regular surgery, but she was discharged in four days pain-free.

“People need help to try to get connected more quickly, and to know what those options are,” she said.

Leave a Reply

Your email address will not be published. Required fields are marked *

universo-virtual.com

buytrendz.net

thisforall.net

benchpressgains.com

qthzb.com

mindhunter9.com

dwjqp1.com

secure-signup.net

ahaayy.com

soxtry.com

tressesindia.com

puresybian.com

krpano-chs.com

cre8workshop.com

hdkino.org

peixun021.com

qz786.com

utahperformingartscenter.org

maw-pr.com

zaaksen.com

ypxsptbfd7.com

worldqrmconference.com

shangyuwh.com

eejssdfsdfdfjsd.com

playminecraftfreeonline.com

trekvietnamtour.com

your-business-articles.com

essaywritingservice10.com

hindusamaaj.com

joggingvideo.com

wandercoups.com

onlinenewsofindia.com

worldgraphic-team.com

bnsrz.com

wormblaster.net

tongchengchuyange0004.com

internetknowing.com

breachurch.com

peachesnginburlesque.com

dataarchitectoo.com

clientfunnelformula.com

30pps.com

cherylroll.com

ks2252.com

webmanicura.com

osostore.com

softsmob.com

sofietsshotel.com

facetorch.com

nylawyerreview.com

apapromotions.com

shareparelli.com

goeaglepointe.com

thegreenmanpubphuket.com

karotorossian.com

publicsensor.com

taiwandefence.com

epcsur.com

odskc.com

inzziln.info

leaiiln.info

cq-oa.com

dqtianshun.com

southstills.com

tvtv98.com

thewellington-hotel.com

bccaipiao.com

colectoresindustrialesgs.com

shenanddcg.com

capriartfilmfestival.com

replicabreitlingsale.com

thaiamarinnewtoncorner.com

gkmcww.com

mbnkbj.com

andrewbrennandesign.com

cod54.com

luobinzhang.com

bartoysdirect.com

taquerialoscompadresdc.com

aaoodln.info

amcckln.info

drvrnln.info

dwabmln.info

fcsjoln.info

hlonxln.info

kcmeiln.info

kplrrln.info

fatcatoons.com

91guoys.com

signupforfreehosting.com

faithfirst.net

zjyc28.com

tongchengjinyeyouyue0004.com

nhuan6.com

oldgardensflowers.com

lightupthefloor.com

bahamamamas-stjohns.com

ly2818.com

905onthebay.com

fonemenu.com

notanothermovie.com

ukrainehighclassescort.com

meincmagazine.com

av-5858.com

yallerdawg.com

donkeythemovie.com

corporatehospitalitygroup.com

boboyy88.com

miteinander-lernen.com

dannayconsulting.com

officialtomsshoesoutletstore.com

forsale-amoxil-amoxicillin.net

generictadalafil-canada.net

guitarlessonseastlondon.com

lesliesrestaurants.com

mattyno9.com

nri-homeloans.com

rtgvisas-qatar.com

salbutamolventolinonline.net

sportsinjuries.info

topsedu.xyz

xmxm7.com

x332.xyz

sportstrainingblog.com

autopartspares.com

readguy.net

soniasegreto.com

bobbygdavis.com

wedsna.com

rgkntk.com

bkkmarketplace.com

zxqcwx.com

breakupprogram.com

boxcardc.com

unblockyoutubeindonesia.com

fabulousbookmark.com

beat-the.com

guatemala-sailfishing-vacations-charters.com

magie-marketing.com

kingstonliteracy.com

guitaraffinity.com

eurelookinggoodapparel.com

howtolosecheekfat.net

marioncma.org

oliviadavismusic.com

shantelcampbellrealestate.com

shopleborn13.com

topindiafree.com

v-visitors.net

qazwsxedcokmijn.com

parabis.net

terriesandelin.com

luxuryhomme.com

studyexpanse.com

ronoom.com

djjky.com

053hh.com

originbluei.com

baucishotel.com

33kkn.com

intrinsiqresearch.com

mariaescort-kiev.com

mymaguk.com

sponsored4u.com

crimsonclass.com

bataillenavale.com

searchtile.com

ze-stribrnych-struh.com

zenithalhype.com

modalpkv.com

bouisset-lafforgue.com

useupload.com

37r.net

autoankauf-muenster.com

bantinbongda.net

bilgius.com

brabustermagazine.com

indigrow.org

miicrosofts.net

mysmiletravel.com

selinasims.com

spellcubesapp.com

usa-faction.com

snn01.com

hope-kelley.com

bancodeprofissionais.com

zjccp99.com

liturgycreator.com

weedsmj.com

majorelenco.com

colcollect.com

androidnews-jp.com

hypoallergenicdogsnames.com

dailyupdatez.com

foodphotographyreviews.com

cricutcom-setup.com

chprowebdesign.com

katyrealty-kanepa.com

tasramar.com

bilgipinari.org

four-am.com

indiarepublicday.com

inquick-enbooks.com

iracmpi.com

kakaschoenen.com

lsm99flash.com

nana1255.com

ngen-niagara.com

technwzs.com

virtualonlinecasino1345.com

wallpapertop.net

nova-click.com

abeautifulcrazylife.com

diggmobile.com

denochemexicana.com

eventhalfkg.com

medcon-taiwan.com

life-himawari.com

myriamshomes.com

nightmarevue.com

allstarsru.com

bestofthebuckeyestate.com

bestofthefirststate.com

bestwireless7.com

declarationintermittent.com

findhereall.com

jingyou888.com

lsm99deal.com

lsm99galaxy.com

moozatech.com

nuagh.com

patliyo.com

philomenamagikz.net

rckouba.net

saturnunipessoallda.com

tallahasseefrolics.com

thematurehardcore.net

totalenvironment-inthatquietearth.com

velislavakaymakanova.com

vermontenergetic.com

sizam-design.com

kakakpintar.com

begorgeouslady.com

1800birks4u.com

2wheelstogo.com

6strip4you.com

bigdata-world.net

emailandco.net

gacapal.com

jharpost.com

krishnaastro.com

lsm99credit.com

mascalzonicampani.com

sitemapxml.org

thecityslums.net

topagh.com

flairnetwebdesign.com

bangkaeair.com

beneventocoupon.com

noternet.org

oqtive.com

smilebrightrx.com

decollage-etiquette.com

1millionbestdownloads.com

7658.info

bidbass.com

devlopworldtech.com

digitalmarketingrajkot.com

fluginfo.net

naqlafshk.com

passion-decouverte.com

playsirius.com

spacceleratorintl.com

stikyballs.com

top10way.com

yokidsyogurt.com

zszyhl.com

16firthcrescent.com

abogadolaboralistamd.com

apk2wap.com

aromacremeria.com

banparacard.com

bosmanraws.com

businessproviderblog.com

caltonosa.com

calvaryrevivalchurch.org

chastenedsoulwithabrokenheart.com

cheminotsgardcevennes.com

cooksspot.com

cqxzpt.com

deesywig.com

deltacartoonmaps.com

despixelsetdeshommes.com

duocoracaobrasileiro.com

fareshopbd.com

goodpainspills.com

kobisitecdn.com

makaigoods.com

mgs1454.com

piccadillyresidences.com

radiolaondafresca.com

rubendorf.com

searchengineimprov.com

sellmyhrvahome.com

shugahouseessentials.com

sonihullquad.com

subtractkilos.com

valeriekelmansky.com

vipasdigitalmarketing.com

voolivrerj.com

zeelonggroup.com

1015southrockhill.com

10x10b.com

111-online-casinos.com

191cb.com

3665arpentunitd.com

aitesonics.com

bag-shokunin.com

brightotech.com

communication-digitale-services.com

covoakland.org

dariaprimapack.com

freefortniteaccountss.com

gatebizglobal.com

global1entertainmentnews.com

greatytene.com

hiroshiwakita.com

iktodaypk.com

jahatsakong.com

meadowbrookgolfgroup.com

newsbharati.net

platinumstudiosdesign.com

slotxogamesplay.com

strikestaruk.com

trucosdefortnite.com

ufabetrune.com

weddedtowhitmore.com

12940brycecanyonunitb.com

1311dietrichoaks.com

2monarchtraceunit303.com

601legendhill.com

850elaine.com

adieusolasomade.com

andora-ke.com

bestslotxogames.com

cannagomcallen.com

endlesslyhot.com

iestpjva.com

ouqprint.com

pwmaplefest.com

qtylmr.com

rb88betting.com

buscadogues.com

1007macfm.com

born-wild.com

growthinvests.com

promocode-casino.com

proyectogalgoargentina.com

wbthompson-art.com

whitemountainwheels.com

7thavehvl.com

developmethis.com

funkydogbowties.com

travelodgegrandjunction.com

gao-town.com

globalmarketsuite.com

blogshippo.com

hdbka.com

proboards67.com

outletonline-michaelkors.com

kalkis-research.com

thuthuatit.net

buckcash.com

hollistercanada.com

docterror.com

asadart.com

vmayke.org

erwincomputers.com

dirimart.org

okkii.com

loteriasdecehegin.com

mountanalog.com

healingtaobritain.com

ttxmonitor.com

bamthemes.com

nwordpress.com

11bolabonanza.com

avgo.top