Focusing on patients part 3

Skull-base surgery team weaves tapestry of survival
(continued)

A CT scan confirmed her fears: A tumor had invaded the ethmoid sinuses, the small cavities between the nose and the eye. Recognizing the severity and immediacy of Cabral's plight, community otolaryngologist Judy Blazun quickly referred her to the UC Davis skull-base surgery team, with whom she'd trained while a resident.

A biopsy on Oct. 7 confirmed the diagnosis: An uncommon carcinoma of the ethmoid sinus had invaded Cabral's right eye socket and penetrated her brain case through the tough covering of the brain, known as the dura.

"We see all these tumors in the northern Sacramento Valley, but that's only 10 or 12 a year," said Donald, who noted that successful skull-base surgery has only developed in the last decade. "Usually the symptoms - nasal obstruction, nosebleeds, sometimes pain behind the eye or in the nose, sometimes numbness over the forehead, cheek or nose - only manifest themselves for a few weeks before they are diagnosed. But some patients have symptoms for a year before they have them checked out."

For a tumor like Cabral's, surgery is standard treatment. The only known causes for this kind of tumor are exposure to hardwood dust in a confined space, tobacco smoking or workplace exposure to radiation, but it is deadly left untreated and a mere 20 years ago would have been considered a death sentence.

"We try to examine the patient, run a full spectrum of diagnostic tests, confirm the diag- nosis and complete the surgery within 14 days," said Donald. "While the tumor is growing relatively slowly, it's fast enough that we need to get to it to prevent it from further invading healthy tissue. Also, this is a time of high anxiety for the patient, so we need to move quickly."

Photo right: Neuroradiologist Bill Nemzek provides surgeons with sophisticated scans of the brain and skull that guide their work in the operating room.