MORGANTOWN, W.Va. – Innovation often requires a specialized set of skills, and Meghan Turner, M.D., WVU Medicine otolaryngologist, has the skills and training necessary to make great strides in the robotic surgical treatment of skull base tumors.
Dr. Turner completed fellowships in both transoral robotic surgery and endoscopic skull base surgery. Because of these skills, she is one of few physicians to perform robotic-assisted transmaxillary surgeries to treat tumors of the infratemporal fossa, an area deep in the head behind the jaw, that result in easier patient recoveries.
“You typically have two routes of training when it comes to treating tumors of the head and neck: open or endoscopic approaches,” Turner said. “Because I am trained in both, I’m able to look at things differently and use minimally invasive techniques to reach some difficult areas. Traditionally, these surgeries required splitting the jaw and palate in order to access the tumor, but robotic assisted approaches allow us to use the body’s natural pathways through the sinuses using a small incision under the lip through the nasal passage (transnasal) or through the mouth (transoral).”
Head and neck tumors are rare and difficult to treat. Often, patients choose radiation and/or chemotherapy because the traditional surgical approaches are invasive and involve painful recovery. The goal of WVU Medicine Otolaryngology and the WVU Cancer Institute is to offer cutting-edge cancer treatment and improve quality of life where possible. With the robotic approach, the patient recovers much faster and has better long-term swallowing and function.
Turner is also the first in the United States to perform a robotic-assisted total laryngectomy. Approaches like these are more popular in Europe, where patients are less willing to undergo radiation because of the long-term side effects.
“We’re trying to offer surgery with the hope of reducing the radiation dose. You can’t always make it so that patients don’t require radiation because some cancers are more aggressive than others, but you can reduce the overall dose in most cases,” Turner said.
“Surgeons in the U.S. aren’t usually trained in transoral surgery for the treatment of laryngeal cancer because it requires endoscopic surgical techniques. A shift toward robotic approaches benefits both the patient and the surgeon. With the robot, I am able to see the surgical field much more clearly than in an open or endoscopic approach. I’m in better control of the tools and camera, reducing the need for a second surgeon to guide the camera while I operate.”
Approaches like this also allow for better visualization that prevent violation of the tumor and help achieve negative margins, such that patients can have adjuvant treatment (radiation and chemotherapy) tailored to the pathology.
According to Turner, clinical research in this area is currently slowed by the rarity of skull base tumors and the lack of dual fellowship-trained surgeons. According to research published by the National Institutes of Health, malignant skull base tumors occur at a rate of 0.44 per 100,000 people.
“These tumors are incredibly rare,” Turner said. “Even high-volume institutions like the M.D. Anderson Cancer Center will only see about 40 cases in 10 years. It makes it difficult to do these cases often, but we can still improve results when done.”