Benign Cranial Tumors: How a Staged Approach Improves Outcomes
Each year, we see dozens of patients with benign cranial tumors at the Eastside Neuroscience Institute. And we’ve learned that, in certain complex situations, combining a staged approach with the latest minimally invasive techniques can relieve symptoms and get patients back to normal life, without many of the risks that accompany larger, more invasive surgeries.
“Most benign cranial tumors can and would be removed completely,” says Amitoz Manhas, MD, MPH, FAANS, “but there are some complex cases where it’s beneficial to do a partial resection and then monitor the patient closely.”
Here are two recent case studies that illustrate the benefits of our approach.
Eliminating Symptoms with a Partial Resection
A 22-year-old man was referred to our surgery team after imaging revealed an epidermoid tumor was compressing his brain stem. The tumor was causing facial numbness and other symptoms. It’s likely that this patient was born with the condition and that it slowly developed into a mass.
“In the past, surgeons would have attempted to do a full resection through a relatively large opening, which created the risk of complications such as infection or nerve injury,” Dr. Manhas says.
Whenever possible, Dr. Manhas and our team of expert team use a staged approach along with minimally invasive techniques to remove enough cells to quell the symptoms. If a tumor is found to be atypical or malignant, the case is discussed with our neuro-oncology tumor board to begin the discussion and referrals with our oncology and radiation oncology partners.
With benign tumors, the team monitors the patient to see if the cells grow and/or symptoms resume. If needed, the patient can undergo additional minimally invasive procedures in the future.
“With a benign, slow-growing tumor, it’s often beneficial to take a more incremental approach that stops the symptoms without the risks of a larger operation,” Dr. Manhas says.
For this patient, Dr. Manhas created used a keyhole approach. He created an approximately ½-inch incision, and used suction and microinstruments to decompress the brain stem by removing the majority of the epidermal cells. The patient went home after just three nights in the hospital.
“All of his symptoms were relieved and he quickly got back to his job and normal daily activities,” Dr. Manhas says. “From here, we will monitor the patient and watch for growth and symptoms. It usually takes years for the symptoms to come back. We could potentially do an additional surgery down the road and hopefully it would be just like this one – a relatively small operation with a quick recovery.”
Minimally Invasive Solution to Nerve Sheath Tumors
In the second case, a 35-year-old male came to us with a plexiform schwannoma that had been monitored for several years by an outside provider. The patient was experiencing pressure, pain and numbness in his neck.
“He had nerve sheath tumors coming off of two nerves on the right-hand side, and he was symptomatic enough that he wanted to see what his surgical options were,” Dr. Manhas says.
A full resection would have required a complicated surgery and likely a fusion in his neck. Dr. Manhas and the patient instead decided to resect the mass up to where it crossed the carotid and vertebral arteries.
“I was able to remove it up to the point where it was dangerous to go any further,” Dr. Manhas says.
The patient’s symptoms resolved following the procedure and a biopsy confirmed the mass was benign. The patient will now require ongoing monitoring.
“If there’s growth in schwannoma components that are higher in his neck, he might eventually need the larger operation,” Dr. Manhas says. “But we took care of the problem he was contending with and hopefully he’ll be symptom-free for many years.”
Building Strong Relationships with Patients
At the Eastside Neuroscience Institute, we work to provide a comprehensive approach and our number one goal is restoring our patients’ quality of life and functional status. We take pride in our relationships with our patients and our referring colleagues.
“Patients quickly realize that we’re not going to dictate what their treatment should be – we’re going to take the time to get to know them, we’re going to understand their goals, and we’re going to tailor care to their medical situation and their needs,” Dr. Manhas says.
We maintain that relationship after surgery, by staying in touch via follow-up appointments and making sure we’re doing everything we can to help patients stay as healthy and happy as possible.
“We stay focused on our ultimate goal,” Dr. Manhas says, “which is for each and every patient to come back to our clinic and say ‘my quality of life is better and I’m feeling great’.”