Image guidance system helps newborn breathe easier
Ten fingers, 10 toes...when Maryan Shah was born on February 5, 2005, she was the picture of perfection, but her delivery team at Brigham and Women's Hospital noticed she was having difficulty breathing. It was then that a barely visible, tissue-like structure was discovered inside her left nostril.
Otolaryngologist Reza Rahbar, DMD, MD, was called to consult on her case, and Maryan was soon transferred to Children's Hospital Boston where a magnetic resonance image revealed that the newborn had a sizeable nasal glioma—a benign congenital tumor—filling the left side of her nose and extending up to her brain, where it was attached to the base of her skull. Since the glioma was inhibiting Maryan's breathing, Rahbar and his team determined it needed to be removed.
"A nasal glioma can generally be removed in one of two ways," says Rahbar, "by an open approach requiring an incision to the face and nose, or by debulking it—surgically removing as much of the tumor as possible—through the nostril."
According to Rahbar, there are pros and cons to both methods. While cutting open the nose typically guarantees removal of the entire tumor, recovery time is longer, and it can leave a facial scar. And debulking doesn't always ensure the tumor will be completely extracted, particularly the extension of the tumor at the base of the skull.
In Maryan's case, Rahbar's team was able to remove the entire tumor through her nostril by using a special image guidance system, the LandmarX Evolution Plus. Using the images from her CT (computed tomography) scan, the system constructed a three-dimensional model of Maryan's head that was then electronically matched to her anatomy during surgery.
"At only 3 days old, Maryan was very small when we performed the procedure," says Rahbar. "So we had to find creative ways to secure the headset portion of the system, adding sponges and towels to make the circumference of her head large enough to attach it." In fact, according to the manufacturer, Maryan is the youngest child in the country to undergo a procedure using this system.
The image guidance system allowed Rahbar to track the movement and location of his surgical instruments in real time throughout the three-hour procedure, using cameras and infrared light to ensure he was removing the full tumor while avoiding other areas of Maryan's nose and brain.
"The surgery was a great success," says Rahbar. "The baby did very well. She was eating and drinking within a day of the procedure and was discharged after only two days."
And mom, Koldia, couldn't be more thrilled. "Dr. Rahbar treated my 3-year-old son when he needed ear tubes, so it was very comforting to see a familiar face," says Koldia, who refers to Maryan as her "inspiration." "But when you're a new mother and it's your child, it's very difficult. I'm truly amazed at this fantastic procedure. I thank God, and I thank the wonderful care team at Children's."
Rahbar and other members of the Department of Otolaryngology have used the image guidance system for 50 or so patients to date—some of whom could not have been treated without it. "This summer, we will begin performing these procedures in the hospital's new state-of-the-art pediatric MR-OR," says Rahbar. "It will allow us to take an MRI scan immediately following surgery to ensure the tumor was completely removed and decrease the need for additional surgery."
