In 1978, Dr. Amin Kassam's mother complained that her head hurt.
"She just awoke one day with a horrible headache," said Kassam, chairman of neurological surgery at the University of Pittsburgh Medical Center. "And then she was in a coma for the next 13 years."
Kassam later found out that what eventually killed his mother was a deeply buried colloid cyst, a benign tumor that blocked spinal fluid from draining out of her skull, putting pressure on her brain.
He dedicated his medical career to finding a way to access such hard-to-reach tumors.
Initially, Kassam pioneered a surgery-through-the-nose technique, removing tumors through the sinuses and nostrils. In the past decade, UPMC doctors have performed more than 1,000 such surgeries. Patients fill the operating rooms every week, some traveling from as far as India.
Now the UPMC team is gaining recognition for surgery through a straw.
"As their techniques are improved and become more widespread, I think this may become first-line treatment for certain abnormalities, like colloid cysts and benign tumors located down in the depths of the brain," said Dr. Alan R. Cohen, chief of pediatric neurosurgery and surgeon-in-chief at Case Western Reserve University's Rainbow Babies and Children's Hospital in Cleveland.
"In many cases, it can enhance the safety of the operation and shorten recovery time for the patient," he said.
The surgical technique is meant for tumors that can't be reached easily with conventional brain surgery. A patient has to be healthy enough to undergo an operation. It does not cost more than conventional brain surgery and typically is covered by insurance.
Through a quarter-sized hole drilled into a patient's skull, surgeons guide a drinking straw-like plastic tube called a neuroendoport -- or endoport -- until it reaches the tumor. A tiny camera slid into the tube beams an image of the tumor onto flat-screen monitors positioned throughout the operating room.
Watching the screens, surgeons painstakingly cut the tumor out and suction away the pieces using small tools with long handles. The endoport guides them, protecting the brain from accidental nicks.
"It's not easier on the surgeon to do it this way," said Dr. Jonathan Engh, Kassam's protege-turned-chief of UPMC's endoport neurosurgery program. "It's easier on the patient. The surgeon has to be very disciplined."
Operating through a tube is not a new way of doing brain surgery, but the method UPMC's team uses is. "What we do is very different; it's a hybrid technique," Engh said. "As far as I know, we're the only ones in the world that do (this surgery) this way."
In typical brain surgery, doctors cut a patient's head from ear to ear, peel back the scalp and saw off the top of the skull to expose the brain and access the tumor.
Last week, Kassam watched and offered guidance as Engh removed a golf ball-sized colloid cyst from the brain of Air Force veteran William Byrd III, 41, of Kingwood, W.Va., about 100 miles south of Pittsburgh.
"It looks like what he's doing is not that hard," Kassam said. "But really look at what he is doing -- the space he is operating through is so small, it's like going through a syringe or a test tube."
Byrd's headaches began after he returned from Operation Desert Storm in 1991. He later served in Operation Iraqi Freedom. A trained mechanic, he began forgetting skills he knew well. He lost jobs because of memory problems. Still, he didn't go to a doctor because he didn't want to ask for help.
"He didn't tell me a whole lot," said his wife, Cheryl. "He didn't want to worry me, I guess."
But shortly after New Year's Day, his headaches and memory loss intensified and he would pass out with little warning. His father, a Vietnam veteran, persuaded him to visit the Veterans Affairs hospital in Clarksburg, W.Va.
"I said to him, 'What if you die? What will your kids do, what about your wife?' " said his father, William Byrd Jr., of Terra Alta, W.Va. "That convinced him."
Doctors at the VA hospital did a brain scan and immediately sent Byrd to UPMC Presbyterian. The scans showed Engh a colloid cyst, and within a week, Byrd was scheduled for surgery.
During a four-hour operation, Engh cut away and suctioned out the greyish-green cyst to reveal a smooth pink opening.
This week, Engh re-examined Byrd. His blinding headaches are gone, replaced with a dull ache from surgery that lessens daily. Byrd no longer pauses before answering questions and loses track less often during conversations.
"He's doing great. I'm really happy," Engh said. "There's a profound difference in his cognition already."
Byrd is unsure whether he'll regain his knowledge of mechanics, but doctors said his memories could continue to return for the next year.
"The type of work I used to be doing was very technical, and I was reduced down to working part time in a deli," Byrd said. "But I'm hoping that I'll be able to work my way back into some kind of technical field.
"Really, I'm just happy to have my life back. It's like I've been freed."
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