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Stanford surgeons collaborate on unusual procedure to preserve patient's speech


Fascinating news out of Stanford Hospital and Clinics today: An otolaryngology surgeon and neurospine surgeon joined forces to perform a rare procedure that involved going through a patient's sinus to remove a speech-impairing lesion from her brain stem.

Surgery of any kind near the brain stem, as one would assume, is highly risky. The traditional route for operating in the area is either the mouth or side of the neck. Both options carry the risk of adverse effects on swallowing, breathing and speech, and they require a long recovery. In the last decade, innovations in imaging technology and surgical tools have recently created another option: the sinuses. This approach, which is known as endonasal odontoidectomy, can often translate into a shorter, less painful recovery.

Despite its advantages, endonasal odontoidectomy is still pretty unusual; it's estimated that the surgery has been done fewer than three dozen times worldwide. Stefan Mindea, MD, and Jayakar Nayak, MD, PhD, recently performed the surgery for the first time at Stanford, and a hospital release provides details of the procedure:

Using extra-long tools, Nayak followed the landmark clivus bone through [the patient's] sinus about 12 centimeters from the nostril margins, until he neared her skull base and the first spinal vertebrae, C1. Then, Mindea took the lead. “I’m not an expert at where the vertebral arteries are like Stefan,” said Nayak, “and those are important for blood supply to the brain.” All along the way, the optical scopes were being washed with automated irrigators to keep the view clear. Extended ultrasonic aspirators were rapidly vibrating diseased bone and soft tissues to be removed at such high frequency it disintegrated and was easily suctioned up.

Photo by Norbert von der Groeben

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