Sunday, May 1, 2011

Arizona, Tucson: New center at UMC to treat tough brain tumors

He's known as the neurosurgeon who successfully operated on U.S. Rep. Gabrielle Giffords after she was shot in the head, but Dr. G. Michael Lemole Jr. is building a reputation in an entirely different area of brain surgery - removing hard-to-reach tumors through the nose.

Lemole and an ear, nose and throat surgeon at Tucson's University Medical Center have established a new center for benign and malignant tumors that occur in the sinus cavities and at the base of the brain. Among other things distinguishing the center is the surgeons' ability to remove large tumors like craniopharyngiomas through the nose, eliminating a need to open up the skull.

Rather than using a microscope as surgeons have done in the past for such surgeries, Lemole uses an instrument called an endoscope, which allows a broader view inside the brain. It's like the difference between looking at a room through a keyhole versus opening the door and getting a panoramic view, he said.

"It's not that through-the-nose surgery is new. It's the new tools and expertise that allow us to put the camera right up front and center at the pituitary level or wherever the target is," Lemole said. "And with those special tools, we're able to reach around corners, and this allows us to take out tumors that we couldn't in the past."

Tumors at the base of the skull are particularly difficult, he said in a recent interview, pulling out a model of a brain and pointing to one section in the bottom.

"Just down here, just in this little tight area, you have the nerves for your hearing, for your facial strength, the nerves for sensation over your face and, of course, your brain stem, which is critical to passing all the information from the brain all the way down the spinal cord. So I have to work in a very tight space and if I have a large tumor that is wrapping around all the structures, it becomes much more complex."

Of about 3,000 board-certified neurosurgeons in the country, only 200 or so specialize in skull-base tumors.

With the advanced technology of the endoscope and using a technique of breaking the tumor down called debulking, they are able to remove tumors through patients' nasal passages.

Lemole and UMC's otolaryngology division chief Dr. Alexander G. Chiu have done about 15 of the minimally invasive nasal surgeries together since establishing the local Center for Sinonasal and Skull Base Tumors four months ago.

Benign pituitary tumors are the most common, but they've also done surgeries together to remove craniopharyngiomas, as well as benign and malignant sinus tumors. They hope to do at least 100 such minimally invasive surgeries per year.

Lemole and Chiu hope their center, unique for its collaboration in an academic setting, will attract patients from across the Southwestern U.S. and eventually become a medical tourism destination for people from other parts of the country and even the world.

They say the key to the center is teamwork. Most neurosurgeons aren't comfortable operating on tumors when they move into the eye orbit or into the nasal space - it's beyond where they typically go. That's where having a specialist like Chiu as reinforcement is a tremendous help.

"Your nose and your sinuses border your brain. So a lot of the tumors that go from the nose can actually go up into the brain," Chiu said. "And a lot of the tumors at the base of the brain can actually hang down into the nose."

Traditionally, to remove a sinus tumor, surgeons would split a patient's lip and pull the face aside.

"You'd be left with a big scar," Chiu said.

The nasal surgeries often take much longer than when the skull is opened up, but the surgery is still more advantageous to the patient, the doctors say.

One of the center's first patients was 49-year-old Tucson aircraft mechanic Eugene Vasquez. The father of three and grandfather of four had a growing brain tumor that he said looked like a peach. It was pressing on his eyes, causing double vision, dizziness and headaches. The whole left side of his face eventually went numb. He'd first been diagnosed in September 2009 when he went to a local emergency room for what he thought was a sinus infection. He was told there might be nothing that could be done.

"It scared the crap out of me," said Vasquez, who had the tumor removed through his nose by Chiu and Lemole Nov. 20. He was released from UMC on Thanksgiving and went back to work a month later. "I got lucky. I was blessed that Dr. Chiu got here at the right time."

Chiu came to Tucson from a 1,000-bed hospital at the University of Pennsylvania six months ago. While UMC, at 487 beds, is less than half the size of the hospital he came from, Chiu said establishing a Center for Sinonasal and Skull Base Tumors in Tucson was an opportunity he wanted to pursue. And working with Lemole, who operated a skull-base tumor center at the University of Illinois in Chicago, was a big part of the reason he took the job, he said. Lemole moved from Chicago to Tucson to become chief of neurosurgery at UMC in October 2009.

Vasquez's tumor was benign, but the terms "benign" and "malignant" can be misleading when it comes to brain growths. Many benign tumors are fatal because of the damage they cause to critical parts of the brain. Chiu told Vasquez his tumor was dangerously large and performed the surgery almost immediately after seeing him.

"When things go beautifully and everything goes well, it's very common for patients to not feel like they've had much surgery," Chiu said. "The biggest advantage we have is that patients will spend a lot less time in the hospital and have a lot less pain."

Not all patients qualify for the surgery. A glioma, for example, would be too high in the brain to qualify. "It has to be at the bottom of the brain so that we can access it through the nose," Chiu said. Such tumors are rare and affect less than 1 percent of the population, Lemole said.

Lemole stressed that the center he's established with Chiu is not solely about removing tumors through the nose. It's about treating all tumors at the base of the skull, he said. The center also works with plastic surgeons, oculoplastic surgeons, radiology, radiation oncology, endocrinologists and neurologists.

"It's a multidisciplinary group," he said. "If the patient needs the minimally invasive approach and we can offer that, we'd love to. If they need the maximally invasive approach where we literally take down their face or take down their skulls in the old traditional ways, we can do that, too."

Lemole still performs trauma surgeries like he did Jan. 8, the day of Tucson's mass shootings, but the skull-base work now comprises most of what he does.

On StarNet: Stephanie Innes brings you the latest health information in her blog, Tucson Health and Wellness, at

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