Pennsylvania study finds through-the-nose brain surgery safe for children

(AP) A surgery in which adults' brain tumors are removed through the nose can also be effective in children, many of whom have no other medical options available, according to a review of cases published this month.

Doctors at Children's Hospital of Pittsburgh in conjunction with the University of Pittsburgh Medical Center reviewed the cases of their first 25 pediatric patients to have the surgery, known as the expanded endonasal approach.

The surgery was successful in all cases, with patients who ranged in age from 3 to 18. None suffered neurological damage, vascular injury or central nervous system infection, the doctors said.

"What we learned from this study is the potential is unlimited," said Dr. Amin Kassam, interim chair of the Department of Neurological Surgery at the University of Pittsburgh Medical Center.

The results were published in the February issue of the Journal of Neurosurgery: Pediatrics. The surgeries reviewed were done from 1999 to 2005 and, so far, Pittsburgh doctors have performed more than 50 similar surgeries on children.

For years, doctors have been doing minimally invasive surgeries that require small incisions and the use of tiny cameras that allow doctors to see into the body. The practice of going through the nose for surgery is also common with pituitary disorders and among ear, nose and throat doctors.

Alan R. Cohen, chief of pediatrics at Cleveland's Rainbow Babies & Children's Hospital, said that doctors from Pittsburgh expanded on that technology to apply it to children with brain tumors and other kinds of congenital and vascular malformations.

Without this technique, the only other option would be going in through a patient's skull and brain, a much more complicated procedure with greater risks, he said.

"The less invasive you can be, the quicker the recovery for the patients," said Cohen, cautioning that the surgery still has risks including leakage of cerebral spinal fluid.

Kassam said that when they first began to apply adult techniques to children, they had to learn more about children's bodies and create smaller instruments.

"When we started, these weren't views we were used to seeing," Kassam said.

He said using the technique on children is especially advantageous because through-the-skull surgery can have long-term effects for a growing child.

Rhonda Firek's daughter, RaeAnn, was one of the first children to undergo the procedure in Pittsburgh. At just 11 months old, RaeAnn began having nosebleeds that worsened until doctors eventually diagnosed the cause: a bundle of veins in her head that had malformed before birth.

There was little doctors could do, because RaeAnn could bleed to death during surgery or a particularly horrible nosebleed. Doctors decided her only hope might be expanded endonasal surgery.

"I was planning her funeral in my mind because these previous few years they were telling me they couldn't remove it," said Firek, of Baldwin.

After three surgeries, RaeAnn's condition was controlled. Now 9, RaeAnn is a happy third-grader. She has lost sight in one eye and still suffers nosebleeds from time to time, but otherwise is fairly healthy.

"We didn't have an option. Eventually, she was going to have an option that was so severe that she would bleed to death," her mother said. "She would have died at some point, I know it."

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