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UAE: Extremely rare tumour that nearly blinded teenager removed through his nose in 6-hour surgery

The tumour affecting Yousif occurs in 1 in 150,000 individuals, with only boys in their preteen and teen ages susceptible to the condition

For 14-year-old Yousif Misbahi, his life was looking bleak after a rapidly spreading rare tumour disfigured his face and caused him partial blindness.

Within just six months, the football-loving youngster was rendered unable to even perform his day-to-day activities, as the tumour caused him to have a bulging eye and severe discomfort.

Now, a team of doctors from Medcare Hospital, Sharjah have given him a new lease of life after performing a risky surgery during which they removed the tumour weighing 105 grams through his nose. The operation, considered a first-of-its kind in the region, was performed after specialists in Morocco and Europe refused to undertake the complex procedure.

The tumour affecting Yousif is called Juvenile Nasopharyngeal Angiofibroma, which occurs in 1 in 150,000 individuals. It is a condition that affects only boys in their preteen and teen ages.

A multi-disciplinary team of ENT doctors, neurosurgeons, anesthetists and intensivists led by Prof. Dr. Janakiram T N and Dr. Saied Alhabash embarked on a groundbreaking scarless, endoscopic surgery that spanned over six hours.

Challenging

Despite being an authority on this kind of tumour, this was a challenging task for Specialist ENT, Prof. Dr. Janakiram T N. “The tumour contains blood and in case I do anything wrong, the patient can die on the operation table,” he said, speaking to Khaleej Times. “Especially because it is around two major arteries which are supplying the brain. The slightest of errors could make a difference between life and death.”

According to Dr. Janakiram, there were several factors to consider before performing the surgery. “The first one was whether we could remove the tumour in a single surgery or if we needed multiple procedures because of its size,” he said. “The second factor was whether we could save his eye because he was already blind in one eye and was losing vision in the other. Another factor was the blood loss. If the tumour starts bleeding, it could cause an ocean of blood, so we had to be careful.”

He explained how the surgery was done. “First, we put a temporary clip on a blood vessel, then used a special technique to remove the tumour bit by bit through his nose,” he said. “We started by removing the outer part of the tumour and worked their way inside the head. Further, we also removed a piece of bone and carefully drilled a specific area. Even as we were doing the surgery, Yousif’s eyes shrunk by 1cm on the operating table.”

This is the first time such a procedure has been attempted in the region. “My team was fully charged up and I had complete trust in them,” he said. “Such a surgery is not possible without a good team of doctors. When I saw their confidence, I knew that this would be possible.”

Emotional moments

For Consultant Otolaryngology Dr. Saied Alhabash, the most emotional moment was when the mother started crying and kissing the doctor’s hands out of gratitude. “She was very, very happy,” he said. “She hugged all the people around there and started praying because she had gone to several doctors in Morocco and other countries in Europe, but no one was ready to do the operation.”

Speaking to Khaleej Times, Yousif’s mother Safa Harris said that the surgery had brought an overwhelming sense of relief to the family. “The weight of uncertainty that had been hanging over us has been lifted, and we are filled with immense joy and hope for the future,” she said. “We are incredibly thankful to the medical team at Medcare Hospital Sharjah for their expertise and dedication, which has given our son a second chance at a healthy life. As a family, we are looking forward to embracing this new chapter in life.”

The tumour

Dr. Janakiram, who is the resident doctor at Royal Pearl Hospital in India, has operated on hundreds of such tumours and is the author of one of the only books on the matter ever published.

A visiting doctor at Medcare Hospital, Sharjah, he cautioned parents to watch out for some signs. “If boys that age complain of regular nose bleeds, that is a cause of concern,” he said. “Also, parents should watch out if there is a change in facial contour and if they have snoring. If any or all three conditions persist, it is best to consult an ENT immediately.”

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