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How do you operate on areas that you can’t easily see or reach? Skull base tumors, which are situated at the junction of the brain and the sinuses, present unique challenges. Many tumors of the skull base that in the past were routinely managed with large, open procedures can now be removed with minimally invasive endoscopic techniques. The Stanford team was one of the early proponents of endoscopic skull base surgery, a relatively new surgical discipline. Leveraging high-resolution imaging platforms and intraoperative surgical navigation technology, surgeons can now precisely map the location of tumors in relation to the brain, eyes, nerves, and vessels to plan the best approaches for complete removal or decompression of the disease process, while also minimizing the risk of injury to critical anatomic structures. By removing skull base tumors through the nose, surgeons can often avoid external incisions and craniotomies, resulting in shorter hospital stays and more rapid recovery. In partnership with neurosurgeons from Stanford, Drs. Hwang, Nayak, and Patel have the expertise to perform endoscopic surgical approaches from the frontal lobe of the brain to the upper cervical spine through an entirely endoscopic nasal approach. For patients with skull base cancers, the extended team also includes radiation oncologists and medical oncologists, working together to offer comprehensive management of the most challenging tumors.
Nasal suffocation, unexplained nasal blockage and dryness, loss of smell, facial or nasal pain, and depression are just some of the wide constellation of symptoms associated with the enigmatic disorder termed empty nose syndrome (ENS). Patients with ENS report that their nose is too open but still describe paralyzing degrees of suffocation, resulting in panic, insomnia, fatigue, anxiety, and depression. Despite the debilitating impact on the quality of life for some patients, there remains ongoing controversy in many circles about the underlying basis, and even the existence of, this syndrome. For Dr. Nayak, these circumstances demand improved research using modern strategies and well-designed studies to understand ENS, and more broadly, nasal airflow and physiology. Although ENS is uncommon, it is frequently associated with past partial or complete inferior turbinoplasty procedures, a nasal procedure performed worldwide. Adding to the complexity, ENS is also occasionally found in individuals who have normal turbinate tissue and intranasal volume. Stanford is one of the leading centers internationally for the diagnosis and treatment of ENS, including innovative turbinate reconstruction procedures. Dr. Nayak is the only surgeon on the West Coast regularly evaluating and performing surgery for ENS, drawing on a national and international referral base. Dr. Nayak has been spearheading patient-centered ENS research, striving to understand the physiology of nasal breathing and how surgical reconstruction options can optimally restore nasal and breathing function.
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