NMCP Staff Members Remove Skull Tumor through the Eyelid for First Time in Military Medicine

Photo By Seaman Imani Daniels | PORTSMOUTH, Va. (August 4, 2020) – Cmdr. Gregory Capra, a Rhinologist and Anterior Skull Base surgeon, and Lt. Cmdr. Gabriel Santiago, a Neuroplastic surgeon, teamed up together to perform a new, minimally invasive surgery to remove a tumor from a patients sinuses. (U.S. Navy photo by Seaman Imani N. Daniels/Released)  

PORTSMOUTH, VA, UNITED STATES

08.07.2020

Story by Seaman Imani Daniels 

Naval Medical Center - Portsmouth

PORTSMOUTH, Va. (July 20, 2020) – Naval Medical Center Portsmouth (NMCP) staff members, Cmdr. Gregory Capra, a Rhinologist and Anterior Skull Base surgeon, and Lt. Cmdr. Gabriel Santiago, a Neuroplastic surgeon, teamed up together, Oct 18, 2019, to perform a new, minimally invasive surgery to remove a tumor from a patient's sinuses.
The bony tumor, located in the patient’s frontal sinus of the forehead was trapping mucous and causing severe pain. Over time, the tumor, if not treated, would have caused erosion of the skull base and a potentially lethal brain infection. This new procedure used to remove the tumor had yet to be performed in any military treatment facility.
“It is a newer procedure that’s being used in civilian academic centers,” Capra said. “It is now being introduced into minimally invasive endoscopic sinus surgery practices. The procedure is not commonly performed so this is the first time that such a procedure is being performed in the military.”
Rather than create a large incision across the patients scalp combined with removal of the skull bone, the surgeons were able to approach the tumor using only a small incision in the eye-lid, combined with endoscopes placed through the nose, to remove the sinus tumor, in an approach formally known as a trans-palpebral orbitofrontal craniotomy.
“The procedure included an approach through the nose to a bony tumor that was along the skull base (the bone separating the frontal sinus cavity and the brain),” Capra said. “My job was to approach it through the nose and [Dr. Santiago] through the orbit where the eyeball is and drill through that bone to access the tumor through the eye.”
The new tactic takes less time perform, taking on average less than two hours in the operating room as opposed to the traditional four to eight hours. It also poses less risk of possible infection due to the less-invasive amount of work in opening the skull, and requires less time for recovery, which is usually an overnight stay with this technique instead of four days or longer.
“Normally the typical approach to that tumor would have involved a very big incision from ear to ear on top of the head and would require all the skin of the forehead to be brought forward to access the tumor,” Santiago said. “In order to save the patient from a much bigger and intrusive surgery and longer recovery, Dr. Capra and I used endoscopic minimally invasive tools to get to the tumor through a different approach.”
Moving forward, the team believes that this type of procedure could most likely be used as a standard practice if surgeons were to come across the same problem again because of the benefits, decreased hospital stay and faster recovery.
“We, in medicine, always have to be pushing ourselves and thinking about ways we can make things better for our patients,” Capra said. “This is an example of approaching a classic problem in a novel fashion. It also shows the value of having centers of excellence in the military and fellowship trained surgeons because it gives us an opportunity to learn techniques that are being practiced on the outside and apply them to our warfighters.”
Santiago further explained how this practice has become a learning experience.
“If there are ways that we can educate patients that come to NMCP of the innovative techniques that we are able to achieve based on our training, it can aide in [patients] making better healthcare decisions,” said Santiago.
As the U.S. Navy's oldest, continuously-operating military hospital since 1830, Naval Medical Center Portsmouth proudly serves past and present military members and their families. The nationally-acclaimed, state-of-the-art medical center, along with the area's 10 branch health and TRICARE Prime Clinics, provide care for the Hampton Roads area. The medical center also supports premier research and teaching programs designed to prepare new doctors, nurses and hospital corpsman for future roles in healing and wellness.

• Date Taken: 08.07.2020
• Date Posted: 08.07.2020 09:55
• Story ID: 375483
• Location: PORTSMOUTH, VA, US