Pune, January 23 , 2025: In a very challenging ENT surgical case, highly experienced surgeons of the city performed 8-hours complex surgery city to remove rare skull base tumour and restored hearing of a 63-year-old patient who was suffering from pulsatile tinnitus—a ringing sensation in the ear that matched the pulse—and heaviness in the ear. The patient was in traumatic condition before the surgery with this ringing sensation.

With this health condition, the patient was admitted at Jupiter Hospital, Pune. MRI and CT scans revealed a rare tumour of 4.5 cm size in the jugular foramen extending from the middle ear to the upper neck. Given the tumour's size and location, the case was referred to a team of highly skilled ENT surgeons at Jupiter Hospital. The surgery was performed by Dr. (Col) Inderdeep Singh and assisted by Dr. Dushyant Khedikar. The procedure required careful dissection to preserve vital structures, including the facial nerve, while ensuring complete removal of the tumour. The entire posterior bony canal was removed above and below the facial nerve along with extended hypotympanum approach.

The surgical case was both challenging and unique, primarily due to the tumor's complex anatomy and critical location. 

Underpining the complexity of the case, Dr. (Col) Inderdeep Singh said, “Situated in the jugular foramen, the tumor extended from the middle ear to the lower part of the neck, necessitating meticulous planning and execution. This area is densely packed with vital structures, including cranial nerves and major blood vessels. The tumor’s proximity to the facial nerve and the 12th cranial nerve posed a significant risk of nerve damage during the operation. Additionally, the highly vascular nature of the tumor created a substantial bleeding risk, making blood loss management a critical concern throughout the procedure.”

The procedure required a multidisciplinary approach, with ENT surgeons leading the operation and a cardiothoracic vascular surgeon on standby to address any unforeseen complications. The surgical team devised a dual approach, simultaneously dissecting through the middle ear and mastoid to access and excise the tumor.

What set this surgery apart was the innovative use of techniques that allowed the complete removal of the tumor without requiring blood transfusions.

"We used micro bipolar cautery along the tumour capsule to meticulously control bleeding.  Additionally, we occluded the internal jugular vein and sigmoid sinus during the procedure, which further minimized blood loss," explained Dr. Singh.

"One of the most gratifying outcomes was the immediate disappearance of the patient’s symptoms, such as pulsatile tinnitus and ear heaviness. The fact that we were able to preserve the patient's hearing while achieving complete tumor excision is a result we are particularly proud of," he added.

The case showcased the importance of precision and teamwork. By preserving key structures and avoiding complications, surgeons achieved excellent outcomes with no neurological deficits. The patient’s family expressed gratitude towards the ENT surgeons and Jupiter Hospital Pune for remarkable restoration of hearing.