Weill Medical College of Cornell University

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Trailblazing Technique in Department of Neurosurgery Cures Patient of Giant Brain Tumor

It was a complicated case, but the patient was cured with no complications. Virgil Perryman had pushed himself a little too hard one day, doubling the length of his daily walk from 4 to 8 kilometers and picking up the pace. He was 350 pounds at the time and on an exercise regime to lose weight. When he returned home after his walk, he collapsed inside the front door, his breathing became labored, everything went black, and he lay on the floor unconscious. His wife, and the emergency workers, believed he had a stroke.

As it turned out, Virgil had a brain tumor the size of a pear in his pituitary gland. To complicate matters, the tumor was pressing on his optic nerve. Virgil had been noticing a loss of vision before the collapse; no longer able to read books, couldn't see well enough to drive, and had lost all peripheral vision. But having turned 60, he chalked this up to just growing older.

After months of scouring the world, including dozens of medical centers and other premier hospitals in the United States, Virgil Perryman's search came to an end. In the Department of Neurological Surgery at the Weill Cornell Medical Center, he finally found a cure for the giant tumor lodged in his brain. Ninety percent of the centers he contacted determined they would have to use traditional surgery to get to the tumor – meaning breaking through the skull. The other 10% had heard of a new technique, and a couple of the centers had some experience using this new technique, but not for a tumor as large as Virgil's.

The day Virgil met and shook hands with Dr. Theodore H. Schwartz was the turning point: "His openness impressed me. I knew I had met the surgeon who had the knowledge, heart and soul, to handle my case. It was obvious to me that he clearly knew what he was capable of doing. He and his colleague Dr. Anand had all the tools and I could tell they had put in the time on this new technique. I was convinced."

Using a trailblazing technique, Dr. Schwartz and colleague Dr. Vijay K. Anand, performed an Endoscopic Endonasal Extended Transsphenoidal Resection of the tumor. In short, they were able to surgically remove a pear-sized tumor from Virgil's brain – not through his skull, but through his nose, piece by piece, without making a single incision in Virgil's skin.

Sounds a bit like medical fiction at first, but Drs. Schwartz and Anand have pioneered and perfected the new technique for 5 years, and they were ready for the challenge. After successfully removing the tumor, today, Virgil is considered cured. In Costa Rica, where the collapse occurred, surgeons had attempted a similar type of approach, but could only remove a tiny piece of the tumor. To date, Drs. Schwartz and Anand have performed over 200 endonasal surgeries; have published a book, Practical Endoscopic Skull Base Surgery; and participate in a yearly training course, Advanced Endoscopic Skull Base Surgery.

Endonasal surgery requires a meticulous and precise approach. High-tech, ergonomically-designed tools provide the surgeons hands with the best feel, while working in a limited surgical corridor, such as the nasal passage. A lighted endoscope with a tiny video camera is inserted into the nasal cavity, which provides a third eye allowing the surgeon a panoramic view of all surgical instruments at any given moment. Stereotactic computerization helps the surgeons to locate and map exactly where the tumor is situated.

Termed Minimally Invasive, or Minimal Access, endonasal surgery is a desirable option, when possible, for patients who wish to be spared surgery that requires a skin incision, opening of the skull, and retraction of the brain. Such invasive surgery, may take up to several weeks for recuperation. Virgil's surgery took only four hours, and he was ready to go home a couple of days later. This was great news for his 2-year old daughter, who welcomed him home with, "Daddy, please don't run so fast anymore."

"The goal was to stay alive to be with my wife and raise our two-year old daughter, says Virgil. Any time anyone goes in for surgery, there is concern. I had told myself the worst case scenario would be to wake up without my sight. But as soon as my eyes opened in the operating room, I could see much more clearly than before. The room seemed very bright. I recognized the faces of the nurse, Dr. Schwartz, and Dr. Anand with clarity, and I realized right away that all my peripheral vision had returned." Another plus following the operation, Virgil lost 50 pounds. He is feeling much healthier and hopes to begin an exercise program again.

Virgil thanks the Department of Neurosurgery, his surgeons, Drs. Schwartz and Anand, and the nursing staff, who he felt were always monitoring and close by. He also has some good news for anyone who may need this type of surgery, "It was just so much easier than I had ever expected."

To reach Dr. Theodore Schwartz, call 212.746.5620.