Minimally invasive brain surgery
Delicate endoscopic procedure removes tumor without incision or long hospital stay
When doctors found a rare and serious brain tumor in the base of Courtney Bascochea’s skull, it was scary enough. Then came the specter of the operation to remove it, which usually involves hours of drilling into the skull.
So when the 27-year-old Vacaville aesthetician learned that UC Davis’ newest neurosurgeon Kia Shahlaie could remove her tumor without an incision – via a minimally invasive procedure conducted through her nose – it was a welcome, if startling, surprise.
“At first it was mind-boggling,” said the outgoing, vivacious redhead, “but when Dr. Shahlaie kept talking about it, it sounded much better than traditional brain surgery.”
Indeed, Bascochea reported no real pain after Shahlaie performed the delicate endoscopic procedure. She was able to leave the hospital in just two days, rather than the typical 5-12 days, and without hair loss, major bruising or other effects on her appearance.
It’s a unique benefit of neurosurgery at UC Davis Health System, where Shahlaie’s rare fellowship-level training in minimally invasive neurosurgery allows him to bypass the more invasive procedures and longer recoveries typical of other Northern California neurosurgery programs.
An extremely rare tumor
— Kia Shahlaie
To Bascochea, the results were especially positive because she’d already experienced brain surgery as a teen. Performed elsewhere, that procedure had corrected an Arnold-Chiari malformation, a congenital structural defect that causes a range of symptoms including dizziness, muscle weakness, headaches and balance problems.
Bascochea described the operation to correct the Arnold-Chiari malformation as a “horrible” experience: surgeons cut and removed spinal bone, and she was forced to quit sports, wear a neck brace and accept other difficult side effects.
When she experienced headaches, dizziness and neck aches again as a twenty-something, Bascochea thought it might be the same condition, until an MRI and CT scan indicated a tumor instead. Bascochea’s Vacaville physician referred her to UC Davis, where the diagnosis was a chordoma, an extremely rare tumor with an estimated incidence of 0.51 cases per million people.
“Courtney’s tumor was located in a very dangerous location for a skull-base tumor, since it is within millimeters of the brainstem,” Shahlaie said. “That region of the brain controls life-supporting autonomic functions such as heart rate and breathing, as well as motor signals sent from the brain to the body.”
Such tumors typically erode through the bone of the skull base and begin to wrap around the brainstem. However, Shahlaie said Bascochea was fortunate: while her tumor had grown towards the brainstem, it had not yet compressed any critical brain structures.
Endoscopic expanded endonasal approach
The traditional, more invasive approach to remove tumors close to the brainstem is a long surgery performed through an incision behind and below the ear – with hours of bone drilling to reach the tumor. Shahlaie, whose extensive training includes the fellowship in minimally invasive neurosurgery and two other areas of neurosurgery, was able to offer an alternative through the endoscopic expanded endonasal approach or “EEA.”
Working with partners in otolaryngology, the technique allows neurosurgeons to pass a camera and specialized surgical instruments to the back of the nasal passage and directly to various regions of the skull base, without scarring and with a shorter recovery.
This technique was first described decades ago for pituitary tumor surgery, but recent advancements and fellowship training now allow subspecialists like Shahlaie to use the endonasal approach to safely remove tumors in a variety of other critical skull-base locations. EEA surgery represents a new advancement in neurosurgery, Shahlaie said, and is quickly becoming the preferred surgical approach for a variety of neurosurgical applications.
Minimally invasive surgery
Shahlaie joined the faculty at UC Davis in 2010 to help advance use of such procedures and direct the development of the new state-of-the-art minimally invasive neurosurgery program. It’s one of several minimally invasive surgical specialty areas offered through UC Davis Medical Center, with others ranging from cardiothoracic and gastrointestinal surgery to oncology and urology.
Comprehensive surgical services
UC Davis offers one of the most extensive and experienced surgical practices in California, including minimally-invasive and robotic-assisted procedures.
Minimally invasive neurosurgery procedures are performed in the recently opened surgery pavilion at UC Davis Medical Center, which includes operating rooms specially equipped for endoscopic surgery. Custom-designed surgical instruments, microscopic lasers and ultrasound machines, and devices that allow for live ‘navigation’ during surgery (akin to “GPS for the brain”) are among the many advanced tools that allow Shahlaie and his colleagues to safely perform minimally invasive brain surgery.
“I immediately felt really comfortable with Dr. Shahlaie – he knew my history and seemed very intelligent,” Bascochea said. “I was worried about (temporarily) losing my sense of smell from the operation, but I knew I didn’t want a scar and to cut my hair and have a big bald spot there. To me it was easy – through my nose and no one will know.”
Tylenol for discomfort
“I couldn’t taste my first post-op Thanksgiving dinner – but other than that, the whole surgery process was easy. I’d had surgery in my head before, and I didn’t want that. I felt good about the results.”
— Courtney Bascochea
The procedure itself wasn’t painful, Bascochea said, and she was up out of bed the morning after the brain operation, using only Tylenol for discomfort. On the second day post-op she left the hospital for home.
Bascochea’s senses of smell and taste were less acute for about two months after the procedure, and she underwent a few nasal cleaning procedures in the otolaryngology clinic.
For a while she reported occasional mild discomfort in her nose during cold weather – since resolved – but said it was a small price to pay for avoiding full-scale invasive brain surgery.
“I couldn’t taste my first post-op Thanksgiving dinner – but other than that, the whole surgery process was easy,” she said. “I’d had surgery in my head before, and I didn’t want that. I felt good about the results. Dr. Shahlaie, the nurses and everyone in neurosurgery were very nice, and there were people with worse problems, so I felt OK.”
Although the operation was relatively painless and Shahlaie was able to remove the entire tumor, Bascochea did undergo a course of radiation treatment elsewhere to help prevent recurrence of the tumor, as she would have after a conventional surgery. To date there is no evidence of a problem on follow-up scans from the 2011 operation, and she’s gone on to get married and – despite the challenges of radiation treatment – bear a perfect and healthy baby daughter, Amaliea Callista James.