A patient at Walter Reed National Military Medical Center has a renewed outlook on life following a complex, eight-hour surgery on March 4th to remove a life-threatening, benign tumor. The successful operation was a testament to the collaborative expertise of U.S. Army Maj. (Dr.) Charles “Chip” Miller, a cerebrovascular and skull base neurosurgeon, and U.S. Army Lt. Col. (Dr.) Anthony “Tony” Tolisano, a neurotologist and program director for Otolaryngology Residency. This intricate procedure offers hope for individuals facing similar diagnoses and highlights the advancements in neurosurgical care available to service members and civilians alike.
The patient had been diagnosed with a vestibular schwannoma, a noncancerous but potentially debilitating tumor that develops on the nerves responsible for hearing and balance. As the tumor grew, it caused significant hearing loss, dizziness, and compromised inner ear function, impacting the patient’s quality of life. While not cancerous, these tumors can become dangerous due to their proximity to critical brain structures. According to the National Brain Tumor Society, vestibular schwannomas account for approximately 8% of all brain tumors. Learn more about vestibular schwannomas here.
“Taking care of patients and teaching residents is the best job,” said Dr. Tolisano, emphasizing the dual mission of Walter Reed’s medical team. The decision to surgically remove the tumor, rather than pursue radiation therapy which only halts growth, was made after careful consideration. “[The patient’s tumor] was a few centimeters in size, which is moderately big and was growing, so we opted to remove it,” Dr. Tolisano explained. “They could have had radiation, but that just halts the growth.”
A Two-Surgeon Approach: Precision and Collaboration
The surgery employed a highly specialized technique known as a trans-labyrinth approach, requiring seamless coordination between Dr. Tolisano and Dr. Miller. This method involves navigating through the inner ear to access the tumor, a delicate process demanding precision and a deep understanding of the surrounding neuroanatomy. Dr. Tolisano, as the inner ear surgeon, initiated the procedure.
“I drilled down and through the inner ear to gain access [to the tumor],” Dr. Tolisano described. “I identified the surrounding nerves, such as the facial nerve that animates the face, the bone around it, and we found the tumor from the balance or “vestibular” nerve.” The facial nerve, crucial for facial expression, and other vital structures were carefully identified and preserved throughout the initial stages of the operation.
Following Dr. Tolisano’s meticulous perform, Dr. Miller, the neurosurgeon, took over, carefully dissecting and removing the tumor from the densely packed area surrounding the brainstem. This region is home to nerves critical for essential functions like hearing, balance, swallowing, and speech. Walter Reed’s Neurosurgery department specializes in these complex cases.
“The goal is not to restore the hearing; it’s to remove the tumor and preserve facial function,” explained Dr. Miller. “These are always challenging as patients are coming in and are very symptomatic, sometimes with a hearing deficit.” The surgeons acknowledged the inherent risks associated with such procedures, prioritizing the preservation of neurological function above all else.
Reconstruction and Recovery
To reconstruct the area following tumor removal, the surgeons placed a titanium plate in the patient’s head, providing structural support and stability. Dr. Miller noted the time commitment involved in these surgeries, explaining that while Dr. Tolisano’s portion typically takes around two hours, his own can range from three to six hours. “I tell patients beforehand that I will take as long as I need to successfully remove the tumor,” he said.
The patient awoke in the intensive care unit (ICU) demonstrating encouraging signs of recovery – able to speak, follow directions, and even eat dinner. Though, some expected facial weakness was present, a common consequence of surgery in this region. The medical team assured the patient that this weakness should gradually improve over time with dedicated rehabilitation and follow-up care.
The patient is now undergoing regular follow-up appointments, including check-ins and brain scans, to monitor their recovery and ensure there is no regrowth of residual tumor. While vestibular schwannomas are not typically treated with chemotherapy, radiation therapy remains an option if any early signs of recurrence are detected. The team anticipates a full recovery within approximately three months, according to Dr. Miller.
A Partnership Forged Over Years
This successful surgery is a direct result of the long-standing collaboration between Dr. Tolisano and Dr. Miller, who have been working together on these types of complex cases since 2020. Their combined training and experience, honed over years of practice, were instrumental in achieving a positive outcome for the patient. “We trained our whole lives to do this,” Dr. Tolisano stated, underscoring the dedication and expertise of the entire medical team at Walter Reed.
The case exemplifies the commitment of Walter Reed National Military Medical Center to providing cutting-edge medical care to both service members and the broader community. The hospital’s neurosurgery program continues to push the boundaries of what’s possible in the treatment of complex neurological conditions.
Disclaimer: This article provides general medical information and should not be considered a substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.
The patient’s continued recovery will be closely monitored, with follow-up scans scheduled to ensure the tumor remains in remission. Walter Reed’s neurosurgery team remains at the forefront of innovative treatments for vestibular schwannomas and other neurological disorders. Share your thoughts and experiences in the comments below.
