A Challenging Skull Base Surgery Gives a Young Patient a New Reason to Hope

When a 15-year-old boy from Kasaragod was referred to Dr. Ajay Kumar in Mangaluru, his family was understandably worried. He had been diagnosed with Juvenile Nasopharyngeal Angiofibroma (JNA), a rare tumour that usually occurs in adolescent boys.

JNA is benign, which means it is not cancerous. But that does not make it a simple condition. These tumours can grow into areas that are difficult to reach and, because they have a rich blood supply, surgery can carry significant risks.

In this case, the tumour had extended to the skull base and was very close to two critical structures - the internal carotid artery near the carotid siphon and the optic nerve at the orbital apex. Any surgery in this area requires careful planning because damage to these structures can result in serious complications, including major bleeding, stroke or loss of vision.

The case was led by Dr. Ajay Kumar, Consultant Surgical Oncologist and Robotic Surgeon, along with Dr. Deepalakshmi, Consultant ENT Surgeon, and Dr. Sanath Bhandary, Consultant Plastic Surgeon. The teams from Anaesthesia and Critical Care were also involved in the patient's care.

Before deciding on the surgical approach, Dr. Ajay Kumar reviewed the patient's scans and medical reports in detail and discussed the situation with his family. For the family, understanding what was happening and knowing what the surgery involved was an important part of making the decision to proceed.

The team opted for a Modified Maxillary Swing procedure, a complex surgical approach that provides access to the skull base. This allowed the surgeons to reach the tumour and work carefully around the surrounding structures.

During the operation, the tumour was meticulously separated from the carotid artery and optic nerve. The surgery was completed successfully, with the patient's vision and neurological functions preserved.

The patient was subsequently moved to the ICU for close observation. He is now recovering well.

For everyone involved, the case was about more than removing a rare tumour. It was also about bringing together different areas of surgical expertise for a situation where there was very little room for error.

Cases involving the skull base often require more than one specialty. ENT surgery, surgical oncology, plastic surgery, anaesthesia and critical care all have an important role to play depending on the location and complexity of the tumour.

This successful procedure at AJ Hospital & Research Centre, Mangaluru, is a reminder of what coordinated surgical care can achieve when specialists work together around a carefully planned treatment strategy.

For the young patient and his family, the most important outcome is a simple one - he came through a difficult surgery with his vision and neurological functions preserved and is now on the road to recovery.