On March 4, a patient at Walter Reed National Military Medical Center underwent a successful eight-hour surgery to have a life-threatening, benign inner ear tumor removed. The operation was a coordinated effort between a surgical team led by cerebrovascular and skull base neurosurgeon U.S. Army Maj. (Dr.) Charles “Chip” Miller, and neurotologist U.S. Army Lt. Col. (Dr.) Anthony “Tony” Tolisano, program director for Otolaryngology Residency.

“Taking care of patients and teaching residents is the best job,” said Tolisano.

The patient was diagnosed with a vestibular schwannoma, a noncancerous tumor that grows on the nerves responsible for hearing and balance. The tumor damaged a portion of the patient’s hearing causing dizziness and compromising inner ear function.

“[The patient’s tumor] was a few centimeters in size, which is moderately big and was growing, so we opted to remove it. They could have had radiation, but that just halts the growth,” said Tolisano.

The complex procedure, known as a trans-labyrinth approach, involves a team effort between the two surgeons.

“I drilled down and through the inner ear to gain access [to the tumor],” said Tolisano, an inner ear surgeon. “I identified the surrounding nerves, such as the facial nerve that animates the face, the bone around it, and we found the tumor from the balance or “vestibular” nerve,” he said.

Following Tolisano's initial work, Miller, a neurosurgeon, dissected and safely removed the tumor from the delicate and densely packed area around the brainstem.This region houses nerves critical for hearing, balance, swallowing, and other vital functions.

"The goal is not to restore the hearing; it’s to remove the tumor and preserve facial function," explained Miller. “These are always challenging because patients are coming in and are very symptomatic, sometimes with a hearing deficit.”

The surgeons placed a titanium plate in the patient's head to reconstruct the area.

Miller explained that Tolisano’s portion of the surgery usually takes about two hours, followed by his, lasting from three to six hours, but he tells patients beforehand that he will take as long as he needs to successfully remove the tumor.

The patient woke up in the ICU, able to speak, follow directions, and even eat dinner, but experienced some expected facial weakness; however, the surgeons said that facial weakness should improve over time.

The patient has follow-up appointments, with subsequent check-ins and brain scans to monitor their recovery and ensure there is no regrowth of any residual tumor. While vestibular schwannomas are not cancerous and do not require chemotherapy, radiation may be considered if there are any signs of early regrowth.

A few weeks after the surgery, the patient is continuing to recover and according to Miller, “expected to make a full recovery in about three months.”

This successful surgery is a testament to the expertise and collaborative spirit of the entire medical team at Walter Reed. Tolisano and Miller have been working together on these types of surgeries since 2020, bringing years of combined training and experience to their patients. "We trained our whole lives to do this," stated Tolisano.

For more information about Neurosurgery and the surgeons at Walter Reed, visit https://walterreed.tricare.mil/Health-Services/Hospital-Care-Surgery/Neurosurgery.