Hospital collaboration saves sight

A collaboration between two local hospitals has saved the sight of a young man from Bradwell.

Two surgeons, one from the Norfolk and Norwich University Hospital and one from the James Paget University Hospital, have brought their skills together in a five hour operation which removed a golf ball-sized tumour from behind a patient’s right eye.

In June 2016, Michael Kneale, noticed that his vision had become blurry. Michael’s father David is an optometrist and was able to conduct an initial eye test to understand what was going on. He identified that Michael had gone colour blind in one eye and was suffering from some form of optic nerve defect.

“Due to signs and symptoms an urgent referral to JPUH was arranged via the GP,” said David. “An MRI scan identified that Michael had a tumour sitting behind his right eye which was pressing against his optic nerve. A biopsy was taken and although we were heartened that things were moving forward, it was a worrying time for us, waiting for the tumour to be identified.”

Michael’s tumour was a benign, ossifying fibroma; a very rare, bony tumour which was growing rapidly. Due to the location of the tumour it was necessary to draw on the expertise of specialist surgeons from both hospitals.

JPUH Consultant ENT surgeon and Rhinologist, Mr Carl Philpott has specialist expertise in the medical and surgical treatment of nasal and sinus disorders having trained in advanced endoscopic sinus and skull base surgery at the St Paul’s Sinus Centre in Vancouver.

Mr Bijan Beigi, Consultant in Ophthalmology at NNUH is a leading expert in surgery of the orbit, the bony socket which houses the eye and the associated structures which support the function of the eye.

Surgery was scheduled for October 2016 and by this time Michael’s right eye was visibly protruding.

Mr Philpott and Mr Beigi decided on a combined endonasal and open approach to address Michael’s tumour, using an endoscope to reach the tumour through the nose in the first instance. Following this an incision was made on the upper eyelid crease of the right eye to reach the orbital part of the tumour from an alternative direction. The depth of the tumour and its proximity to the optic nerve meant that the team had to work within the finest of margins to prevent lasting damage to the eye.

A navigation system, which tracked suction instruments using an electromagnetic field during the operation was utilised to enhance precision. The system allowed the team to identify the exact location of the instrument, tumour and surrounding tissues during the course of the tumour removal by tracking the instruments relative to pre-operative scans.

The surgery successfully removed the entirety of the tumour in the orbit which would have continued to grow, had any of the tissue been left behind. Once the tumour had been removed, a small synthetic implant was secured between the tumour space and the eye to support the surrounding tissue and prevent a collapse of the eye socket.

Michael spent two days in hospital following the operation and his recovery is continuing to progress well. Three months after the operation, Michael is enjoying normal life with his family.

Michael, now 21, said: “I knew I was in good hands and now I’m feeling really well. It’s been such a whirlwind and it’s nice to be able to relax after everything that has happened.”

His father David said: “We’re absolutely delighted with the result of the operation. It was such a nerve-wracking prospect but we knew there was no option but to remove the tumour as Michael would have lost his sight. Having a detailed knowledge of the physiology of the eye means I’m even more impressed with how the team managed to get to the tumour and remove all of it; it’s just mind-boggling!”

Michael’s progress will continue to be monitored at annual consultations with follow-up from both consultants.

Mr Carl Philpott said: “This was always going to be a difficult case and with such a rare tumour, it was great to be able to combine efforts with Mr Beigi and his team for the best possible outcome for Michael. It was an excellent demonstration of how networked resources between trusts, specialties and colleagues can be harnessed for the greater good and I hope we are able to continue this fruitful collaboration.”

Mr Bijan Beigi added: “This is an extremely rare condition and the placement of Michael’s tumour was particularly precarious. Bringing our skills together as specialist consultants and utilising state of the art technology to support treatment has delivered an excellent result for our patient. I’m so pleased that Michael is recovering well and look forward to working with Mr Philpott and his team in the future.”

Thanking both consultants, David Kneale added: “The collaboration between the two hospitals has been great and we couldn’t have asked for better care. We were truly privileged to have all that expertise around one table.”

Pictured L-R: NNUH Consultant in Ophthalmology, Mr Bijan Beigi with Michael Kneale and David Kneale