New Fully Endoscopic Treatment for Olfactory Groove Meningiomas: Despite Being Told That it was "Virtually Impossible" Texas Man Undergoes Minimally Invasive Brain Surgery and Preserves his Sense of Smell
DUNCANVILLE, TX (May 29, 2002) -- A Duncanville, TX, construction manager has become one of the first in Texas to have an olfactory groove meningioma (benign brain tumor) removed in a minimally invasive procedure at Cedars-Sinai Medical Center's Skull Base Institute in Los Angeles. Although Dave Galbraith, age 64, had been told by four neurosurgeons in Texas, Maryland and Massachusetts that he would inevitably lose his senses of smell and taste if he had the tumor removed, Skull Base Institute surgeons successfully removed the tumor in a fully endoscopic approach, preserving his olfaction function and leaving only a tiny, nearly invisible scar on the bridge of his nose.
According to skull base surgeon, Hrayr K. Shahinian, M.D., Director of the Skull Base Institute, the four-hour surgery was done using an innovative endoscopic frontal craniotomy approach pioneered by surgeons at the Institute. Known informally as the "Cyclops" procedure, this minimally invasive approach requires only a tiny incision between the patient's eyes at the bridge of his nose. "Because the point of entry is so small, and because we do not have to disturb the frontal lobes of the brain or the olfactory tracts, the patient nearly always preserves his sense of smell and taste when the "cylcops" approach is used," said Dr. Shahinian. "In addition, the patient experiences far less discomfort, has fewer complications and enjoys a much faster recovery."
Galbraith is a case in point. His story began in 1996 when he had quadruple heart bypass surgery. Since that time, he has seen his primary care physician (PCP) every six months for a check-up. As he was preparing for one of these regular check-ups in June 2001, his wife, a registered nurse, urged him to ask the doctor about increasing tremors in his right hand.
The PCP referred him to a neurologist who ordered an MRI to see if the brain was causing the tremors. Three days later, Galbraith received a call from the neurologist: "I have your MRI results, and I'd like you to come in right away," he said.
Apprehensive, Galbraith scheduled an appointment immediately. At the neurologist's office, he looked at the MRI along with the physician and saw what appeared to be a white cotton ball located between his eyes. The neurologist said that the tumor was not causing his hand tremors but that it must be removed before serious symptoms developed. The doctor explained that it was a 3 cm meningioma, a type of tumor that originates from the meninges, membrane-like structures that surround the brain and spinal cord.
Meningiomas account for about 15 to 20 percent of all primary brain tumors and are nearly always benign. Although there is no known cause for this type of tumor, it usually occurs in mid-life - during a patient's 40s, 50s or 60s.
Although Galbraith was not experiencing seizures or other symptoms, as a precaution the neurologist prescribed an anti-seizure medication. Before taking the medication, however, Galbraith decided to see a Dallas neurosurgeon who told him that the tumor needed to come out within six months. The doctor explained that he would remove the tumor using a bi-frontal approach, pulling the brain back for access to cut out the tumor. In the process, nerves would be stretched and cut that would result in permanent loss of smell and taste.
Discouraged, Galbraith went home, deciding to seek another opinion and to conduct his own research. A second neurosurgeon held out a little more hope. He would use a sub-frontal approach. This would result in a smaller opening without brain manipulation, but it was still very unlikely that Galbraith would be able to smell or taste after the operation.
Meanwhile, Galbraith was spending many nights online, searching for information about his type of tumor and treatment options. While visiting a "chat room" hosted by Johns Hopkins Medical Center, he left a message asking anyone with more information to contact him. To his surprise, he quickly received an e-mail message with an attachment from a stranger who had also been visiting the chat room.
The attachment was a June 21, 2000 news release from Cedars-Sinai's Skull Base Institute describing a fully endoscopic, minimally invasive approach for treating various types of brain and skull base tumors.
Galbraith called the Skull Base Institute, then overnighted his MRI films for review. A few days later Galbraith got a letter back. "Yes," said Dr. Shahinian. Based on what he was seeing in the films, he would be able to remove the tumor and felt that he could preserve Galbraith's senses of smell and taste.
Delighted, but thinking that this news was too good to be true, Galbraith took Dr. Shahinian's letter back to his second-opinion neurosurgeon and second neurologist for comment. The neurosurgeon still felt that it would be impossible to save his sense of smell and that there was no need to go to Los Angeles for the surgery. But the neurologist encouraged him to pursue the minimally invasive "cyclops" approach.
After speaking with two of Dr. Shahinian's patients who had undergone the same type of surgery and learning that both of them could still smell, Galbraith's mind was made up; he was going to L.A.
When Galbraith awoke in the recovery room following surgery, Dr. Shahinian held a saturated cotton ball under his nose. Galbraith exclaimed, "That's rubbing alcohol! I can smell it!" The next morning Galbraith enjoyed the aroma and taste of hot coffee and hot cereal! Three days after his operation he left the hospital, and four days later he flew back home to Duncanville, Texas.
Today, three months later, Galbraith is back to a normal workday without limitations. He is taking no prescriptions for pain, and his scar is invisible unless he removes his glasses and an observer stands very close.
He strongly urges others who think they may need surgery to not be afraid to seek second, third or even fourth opinions. "I consulted four neurosurgeons and two neurologists before I found Dr. Shahinian," he says. He also encourages people to do their own research and to ask lots of questions. "Become a student," he says, "so you can ask critical questions and make the best decisions for you. Also, get copies of all your medical records."
Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
MENINGIOMA FACT SHEET
- Meningiomas are tumors that originate from the meninges which are membrane-like structures that surround the brain and spinal cord. Typically they are benign and occur as solitary masses, but instances of malignancy and multiple concurrent lesions have been reported.
- About 15 to 20% of all primary brain tumors are meingiomas, and commonly occur in the fourth through the sixth decade of life, affecting predominantly women. Despite various theories the origin and cause of the
tumors is unknown.
- Since the meninges surround the entirety of the brain and spinal cord, meningiomas can occur anywhere in the central nervous system. Signs and symptoms depend on the size and location of the tumor. Symptoms usually develop as a result of compression of surrounding neurovascular structures.
- Intercranial meningiomas may manifest as headache, stroke, seizure, loss of vision, or personality change. Meningiomas of the spinal cord may present with pain or weakness at the level of cord involvement. Due to their slow growth characteristics development and progress of symptoms can be subtle and extend over a period of years.
- Diagnosis begins with a thorough documentation of the patient's medical history, including a detailed description of the onset and duration of the symptoms, and a complete physical examination focused on neurological findings.
- Treatment options are varied ranging from conservative expectant therapy to aggressive surgical resection. Therapy must be tailored to the needs of the patient. Elderly patients or those with multiple medical diseases who are at greater risk for surgical procedures may benefit from observation with periodic MRI studies, radiation therapy, or radiosurgery.
- Tumors once thought to be "unresectable" are now regularly and safely removed at the Skull Base Institute. Meningiomas located at the base of the skull are very difficult to access. Using highly specialized surgical techniques, sophisticated intraoperative monitoring equipment, and minimally invasive surgical instruments facilitates exposure of hard-to-reach areas in their entirety without disturbing surrounding critical neurovascular structures.