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NMC Portsmouth surgeons take unique approach to remove skull tumor

Image of Two medical personnel holding a skull. Navy Cmdr. Gregory Capra, a rhinologist and anterior skull base surgeon, and Navy Lt. Cmdr. Gabriel Santiago, a neuroplastic surgeon, teamed up to perform a new, minimally invasive surgery to remove a tumor from a patient’s sinuses. (Photo by Navy Seaman Imani Daniels, NMC Portsmouth.)

Naval Medical Center Portsmouth (NMCP) staff members, Navy Cmdr. (Dr.) Gregory Capra, a rhinologist and anterior skull base surgeon, and Navy Lt. Cmdr. (Dr.) Gabriel Santiago, a neuroplastic surgeon, teamed up last fall to perform a new, minimally invasive surgery to remove a tumor from a patient's sinuses.

The bony tumor, located in the frontal sinus of the forehead, trapped mucous and caused severe pain. Over time, the tumor, if not treated, would have caused erosion of the skull base and a potentially lethal brain infection. The new procedure used to remove the tumor had yet to be performed in any military medical treatment facility.

“It is a newer procedure that’s being used in civilian academic centers,” Capra said. “It is now being introduced into minimally invasive endoscopic sinus surgery practices. The procedure is not commonly performed so this is the first time that such a procedure is being performed in the military.”

Rather than create a large incision across the patient’s scalp combined with removal of a portion of skull bone, the surgeons were able to approach the tumor using only a small incision in the eye-lid, combined with endoscopes placed through the nose, to remove the sinus tumor, in an approach formally known as a trans-palpebral orbitofrontal craniotomy.

“The procedure included an approach through the nose to a bony tumor that was along the skull base (the bone separating the frontal sinus cavity and the brain),” Capra said. “My job was to approach it through the nose and [Dr. Santiago] through the orbit where the eyeball is and drill through that bone to access the tumor through the eye.”

The new tactic takes less time to perform, on average less than two hours in the operating room as opposed to the traditional four-to-eight hours. It also poses a lower risk of infection due to the less-invasive approach to opening the skull, and requires less time for recovery, usually an overnight stay instead of four days or longer.

“Normally the typical approach to that tumor would have involved a very big incision from ear to ear on top of the head and would require all the skin of the forehead to be brought forward to access the tumor,” Santiago said.

Moving forward, the team believes that this type of procedure could be used as a standard practice with such tumors because of the benefits, decreased hospital stay, and faster recovery.

“We, in medicine, always have to be pushing ourselves and thinking about ways we can make things better for our patients,” Capra said. “This is an example of approaching a classic problem in a novel fashion. It also shows the value of having centers of excellence in the military and fellowship trained surgeons because it gives us an opportunity to learn techniques that are being practiced on the outside and apply them to our warfighters.”

Santiago said he also sees value in educating patients. “If there are ways that we can educate patients that come to NMCP of the innovative techniques that we are able to achieve based on our training, it can aide in [patients] making better health care decisions,” said Santiago.

As the Navy's oldest, continuously operating military hospital, Naval Medical Center Portsmouth serves past and present military members and their families. The nationally acclaimed, state-of-the-art medical center, along with the area's 10 branch health and TRICARE Prime Clinics, cover the Hampton Roads area. The medical center also supports premier research and teaching programs designed to prepare doctors, nurses, and hospital corpsmen for careers in healing and wellness.

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Last Updated: July 11, 2023
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