Skull Base Program team removes tumor from nasal passage

Batra, Sanker
From left: Dr. Pete Batra interviews patient Melinda Sanker

By Robin Russell

In late 2010, Melinda Sanker began experiencing nasal obstruction and pressure in her face. Her general practitioner in Fort Worth diagnosed a sinus infection and prescribed antiobiotics and steroids. But the pressure grew, until Ms. Sanker’s breathing became obstructed.

Eventually she could see something in her nose. Her doctor thought it was a polyp and referred her to an otolaryngologist, who agreed it was a polyp that needed removal. By this point, she wanted a second opinion. A second otolaryngologist performed a biopsy in his office, and within 30 minutes had a diagnosis: It was cancer.

“I was devastated. I was only 41. Even hearing the word ‘biopsy’ I began to feel fear,” she recalled. “I didn’t expect that at all.”

She had two options.

  • She could be referred to a surgeon in Fort Worth who would perform a craniotomy, a surgical procedure that involves removing the bone flap and exposing brain tissue. Not surprisingly, Ms. Sanker was reluctant to undergo such a radically invasive procedure.
  • She could see skull base specialist Dr. Pete Batra, Co-Director of the Comprehensive Skull Base Program, who has performed the same tumor resection surgery through a patient’s nasal passages using endoscopes.

It was an easy choice.

Within a week, Dr. Batra scheduled surgery for Ms. Sanker at University Hospital - Zale Lipshy. Using the endoscopic procedure, the skull base surgical team removed the entire tumor through the nasal passages, thus avoiding any incisions on her skull and face.

“It was stuck next to her eye,” said Dr. Batra, Associate Professor of Otolaryngology. “We were able to remove all of it without putting her eye in any sort of jeopardy. Some of the tumor extended up to the bony plate that separates the sinuses from the brain — that’s called the skull base. We removed all of that as a margin, and she didn’t need a craniotomy. She was discharged two days later, which is pretty remarkable.”

Skull base disorders can be complicated because the area involves the bony shelf separating the brain from the eye sockets, nasal cavities, ear canals and upper neck. Major nerves, blood vessels and other structures pass through this area.

That’s why the skull base surgery team includes physicians from otorhinolaryngology (head and neck surgery), neurosurgery, neuro-ophthalmology, neuro-oncology, radiation oncology, interventional radiology and pathology.

“I think we’re very unique in that few skull base programs have the same level of expertise across all the disciplines,” said Dr. Batra.

Most skull base disorder patients at UT Southwestern, for instance, are able to avoid having a craniotomy because of the level of surgical expertise the team provides. Dr. Batra has performed this kind of endoscopic tumor surgery more than 200 times in the last eight to nine years.

It’s not uncommon, however, for patients with skull base disorders to be misdiagnosed as having allergy problems or sinusitis.

“It happens all the time, unfortunately,” Dr. Batra said. “But patients who have rapidly progressive nasal blockage, swelling of the eye, significant nasal bleeding, a lump in the neck, numbness in the cheek – those are not normal types of symptoms.”

Ms. Sanker has been cancer-free since her surgery nearly a year ago and is glad she found a physician with expertise in endoscopic surgery.

“I’m so thankful for him and his talents,” she said of Dr. Batra. “I felt so reassured by the staff at UT Southwestern that they could take care of this. I have been so pleased.”