Surgeons have removed a 2.5cm brain tumour through a patient’s eye socket, reports The Straits Times.
The eight-hour surgery was performed by teams from the National Neuroscience Institute (NNI) and Tan Tock Seng Hospital (TTSH) in Singapore.
This was the first time the technique had been used to remove a tumour.
Patient Teong Wen Han, a learning and development manager, suffered a seizure before crashing his car. A scan revealed a 2.5cm brain tumour behind his right eye.
The location of the tumour made it difficult to reach with the traditional open approach, and it was also in a high-risk area.
NNI neurosurgeon Jensen Ang explained: ‘Due to its location, it was more difficult to reach – because it is at the base of the skull and the brain is on top of it. It was also quite close to the optic nerve as well as some of the blood vessels and the cranial nerve that controls eyeball movement.’
Two neurosurgeons – Dr Ang and Associate Professor Ang Beng Ti, an ophthalmologist, and an ear, nose and throat (ENT) specialist, opted for the minimally invasive surgical technique through the eye socket – transorbital neuroendoscopic surgery (TONES).
Professor Ang, a senior neurosurgeon, said: ‘Surgery is all about developing the safest corridor of approach to something so that we do not disrupt critical structures along the way. The covering of the brain (or the meninges) needs to be cut. That is the layer from which the tumour arises. When we see the tumour, we remove it by peeling it away from the surrounding brain structures.’
He further noted that traditional open skull surgery can leave visible long-term effects, including facial asymmetry due to muscle wasting around the surgical site.
With the TONES technique, surgeons accessed the brain through tiny incisions in the eye socket.
Prof Ang said it was ‘critical that the specialists on the team worked together to really pull off this landmark case’.
Eye specialist David Law from TTSH said his role was to ensure the neuro- and ENT surgeons had unobstructed access through the eye socket to reach and remove the tumour. He also made sure that the optic nerve was not damaged during the surgery by constantly checking Mr Teong’s pupils.
ENT surgeon Tan Jian Li’s role was to enable the surgeons to see inside via an endoscope. Dr Tan, who is from TTSH, said that essentially, there were four instruments inside the eye socket during the surgery.
Mr Teong was discharged without any neurological or eye complications.
