Seeking the top neurosurgical experts in the world, a young Spanish pharmacist, whose life-threatening brain stem tumor had not been adequately treated in her native country, traveled to the Chan Soon-Shiong Neuroscience Institute at Saint John’s Health Center in November 2009 to have her tumor successfully removed through her nose without an incision.

Isabel suffered from an aggressive tumor called a chordoma that had wrapped itself around major arteries in the base of her skull. Adhering to the brain stem, the tumor not only pressed on the optic nerve, but had also damaged her pituitary, the master gland that controls the body’s hormonal function.

When she arrived at Saint John’s, Isabel had lost most of the vision in her left eye and was plagued by severe headaches. She faced continued deterioration—even death—from progressive brain stem compression if her tumor could not be removed. After an attempt by doctors in Spain to remove the tumor, her condition had been deemed inoperable. The initial surgery not only was unsuccessful, but also destroyed healthy tissue needed for reconstruction and left her with a permanent drain in her head to handle a fluid leak that the procedure had created.

Amin Kassam, MD, Director of the Neuroscience Institute, and Daniel Kelly, MD, Director of the Brain Tumor Institute, chose the expanded endonasal approach for Isabel—an advanced strategy that provides surgical access to the brain through the nostril. These two internationally renowned neurosurgeons have more than two decades of combined experience pioneering this minimally invasive technique and have successfully used it on more than 2,000 patients.

“We also employed a technique called ‘pituitary transposition,’ which moves and then returns the pituitary gland to its original position,” explained Dr. Kassam. Working through the nostril with specialized instruments, the surgical team moved from the center of the tumor outward, taking out the majority of the tumor without destroying critical structures surrounding it. Once the bulk of the tumor had been removed, the pressure that had been injuring the patient’s brain stem and optic nerve was relieved.

“My recovery was very fast,” said Isabel. “In two days, I was walking. Less than a month after surgery, I’m still feeling fine. I can lead a normal life and have regained practically all of the vision in my left eye.”

Isabel is currently in Spain, but will return to the Saint John’s in March for evaluation. “Chordomas are complex, aggressive tumors that are rarely cured by surgery alone,” Dr. Kassam explained. “Isabel may require a course of radiation to prevent tumor growth.”

Although she may need additional treatment, Isabel has a very positive opinion about her experience. “At Saint John’s, I found a hospital where patients can receive treatment at the highest level,” said Isabel. “Dr. Kassam and Dr. Kelly are among the best neurosurgeons in the world, and I will be eternally grateful for their knowledge, support, kindness and compassion.”