Skull Base Home

Woman's brain surgery choice controversial
by Lisa Kim Bach, Las Vegas Review-Journal

When Matty DeMeo-Phillips was diagnosed with a benign tumor growing on her eighth cranial nerve, she took the matter of her brain into her own hands.

The tumor explained her loss of hearing, the ringing in her ears and the increasing difficulty she was having in walking a straight line, all symptoms that caused her family doctor to refer her to an ear, nose and throat specialist. A magnetic resonance image revealed a growth about the size of a pea behind her left ear.

DeMeo-Phillips, 51, said the specialist told her she had just one option - surgical removal of the slow-growing tumor, which required a craniotomy above the ear and retraction of the temporal lobe of the brain. Leaving the acoustic neuroma in place could make her condition worse if it became larger.

"He told me I needed to get it out," DeMeo-Phiiips said Saturday. "I was too young to just leave it there."

DeMeo-Phillips had researched her condition on the Internet and asked the local specialist about endoscopic brain surgery. Endoscopic surgery is performed through a dime-size opening behind the ear, and DeMeo-Phillips saw it as being less risky and invasive than traditional treatment.

The question landed an unknowing DeMeo-Phillips in the middle of a brewing debate within the medical community on whether the endoscopic procedure is an acceptable alternative to conventional brain surgery.

"The specialist said, 'You wouldn't want to be someone's guinea pig,'" recounted DeMeo-Phillips, who was brought up short by the negative reaction.

She got a much different response when she asked her family physician the same question.

"He turned around and said that I needed to go where I felt most comfortable," DeMeo-Phillips said.

So she did. DeMeo-Phillips decided not to pursue her specialist's referral for traditional treatment and instead made an appointment with Dr. Hrayr Shahinian, director of the private Skull Base Institute in Los Angeles and an expert in the field of endoscopic brain surgery.

Shahinian - who recently made national news for volunteering to remove a tumor from David Dingman-Grover, a 9-year-old who sold bumper stickers on e-Bay while trying to raise money for his surgery - evaluated DeMeo-Phillips and approved her as a candidate for endoscopic surgery.

She left Henderson on Sunday and underwent the procedure on Monday at Cedars Sinai Medical Center. The surgery went well, according to her doctor's office, and DeMeo-Phillips should be able to return home later this week.

"Don't think for a minute I'm not freaked out about this," DeMeo-Phillips said Saturday. "But this is two days in the hospital versus two weeks, if all goes well. I pray to God that's what transpires."

Shahinian, who champions endoscopic brain surgery as a minimally invasive procedure that reduces the risk to which a patient is exposed, predicts it will one day become a standard treatment for the removal of tumors. Endoscopy utilizes fiber optics and a high definition television monitor to facilitate tumor removal.

Compare that with traditional surgery, Shahinian said, which requires cutting the skull open, drilling for hours and pushing the brain aside to reach a tumor. "The human brain does not like to be manipulated," said Shahinian, who has had patients travel from New Mexico, Florida and Michigan to undergo endoscopic surgery. "We want to be like a thief in the night. We want to get in and get out without the brain ever knowing that we've been there."

The procedure is not experimental, he said, but the question of how it should be used is controversial among his colleagues. Shahinian is disappointed by the reluctance of neurosurgeons to broaden the use of endoscopy in brain surgery, but said he isn't surprised. Medicine is a conservative field and history underlines that, Shahinian said.

"Anytime there is innovation, there is controversy," Shahinian said.

Dr. Ghassan Bejjani, who specializes in the treatment of skull base tumors at the University of Pittsburgh Medical Center and is a spokesman for the American Association of Neurological Surgeons, said the controversy around endoscopic brain surgery is rooted in the lack of research to support its broader use.

Endoscopic surgery is widely accepted as a treatment for pituitary tumors, but the case for using it to remove other types of brain tumors has not been decisively made.

"The jury is still out on it, except in the case of pituitary tumors," Bejjani said Monday.

His opinion is partly based on his own experience with the procedure. Bejjani said there is increased risk of hemorrhage in using endoscopic surgery, as well as the problem of how to widen the field of surgery should complications arise. For instance, if a problem occurs during an abdominal procedure, the surgeon can always make a bigger incision.

It's a much more complex thing to do during a brain surgery, Bejjani said.

"I did a fellowship in minimally invasive surgery and I didn't see an advantage to it," Bejjani said.

Endoscopic brain surgery is performed in Las Vegas, said Dr. John Anson, who is codirector of the Nevada Neurosciences Institute at Sunrise Hospital and Medical Center.

Anson is one of a handful of surgeons that offer it as an option to their local patients. Rejecting endoscopic brain surgery out of hand is old-school thinking, Anson said. But at the same time, the method is still a developing one with applications the medical community is working to understand.

"It is a technology that's still evolving," Anson said Monday. 'We're still learning how best to use it and in what situation to use it."