Mr Bassel Zebian, a consultant neurosurgeon at King’s College Hospital, has adapted an endoscopic ultrasonic aspirator - a device that uses ultrasonic vibration to fragment a brain tumour and remove it - in order to carry out minimally invasive neurosurgery for deep tumours that would otherwise be extremely difficult to access.
In January 2018, 14-month-old Octavia Begbey became restless during the night, something her parents initially put down to teething. She soon started vomiting and developed a stiff neck so her parents, Richard and Charlotte, rushed her to the local hospital in Tumbridge Wells. There, Octavia had a CT scan and it was discovered that she had a brain tumour the size of a golf ball in the middle of her brain, causing life-threatening obstruction and build-up of fluid (hydrocephalus).
Octavia was transferred to King’s as a matter of urgency. Richard said: “We met with Mr Zebian when we arrived who told us that if Octavia was not operated on, she was unlikely to survive. He explained that once the tumour had been removed, it was possible that our daughter would have some form of learning difficulty or physical disability due to the location of the tumour.” Mr Zebian then explained to the parents that one way to reduce the risk of damage to her brain was to use a minimally invasive technique with a small incision and a tiny corridor through brain to access the tumour.
That evening, Octavia was in surgery for 22 hours while Mr Zebian and his team worked to remove the tumour through a small hole in the skull. The tumour turned out to be benign, and 80% of it was removed in that first operation, with the remainder removed a few months later.
The technique Mr Zebian uses in selected patients, such as Octavia, is the equivalent of keyhole surgery in the brain. The procedure is performed through a neuroendoscope - a small metal tube with a camera at the tip and a channel to allow instruments to pass through. In Octavia’s case, a hole about 9mm wide was made in the skull for the endoscope to be inserted. Mr Zebian initially used a variety of adapted instruments to remove tumours endoscopically until he was able to modify an endoscopic ultrasonic aspirator to fit through a specific endoscope. This has allowed him to navigate the ventricles of the brain and reach very deep lesions and remove them with minimal damage to the surrounding healthy brain. The alternative technique would have resulted in a much bigger corridor, a few centimetres in diameter, through the healthy brain to allow access to the deep tumour.
Mr Zebian said: “This technique minimises damage to the healthy brain whilst maximising visualisation of and access to deep tumours. The difficulty neuroendoscopic surgeons often face is the control of bleeding and the lack of adequate instrumentation. With our modification of existing instruments we have been able to push the limits of minimally invasive resections in the best interest of our patients and we are increasingly able to resect even large, deep, solid tumours with one of the biggest cases series in the world.”
Octavia had her last surgery on 10 May last year (2018) and is doing exceptionally well, with no signs of brain damage at all – she’s top of her peer group and her parents say the surgery has had no negative effects on her at all.
On 10 May, one year on from Octavia’s last operation, Richard and Charlotte will be walking 50km from their home in, West Malling, Kent to Richard’s office in the City of London to raise money for another endoscope, which will mean that more of the same type of surgery can be carried out. The 50km signifies the distance Richard walked while pacing up and down the Lion Ward corridor at King’s, trying to get Octavia to find peace and sleep ahead of her operation.
Richard added: “We can never repay the debt of gratitude we owe Mr Zebian and the team at King’s for saving Octavia’s life but we would like to try by helping them save more lives.”
If you’d like to find out more about Richard’s fundraising or donate, further information can be found here https://fticonsulting.benevity.org/community/fundraiser/view/43