Ground-Breaking Surgery

This is an MRI showing a tumor (the white mass) right behind the eyes of Sharon Brynes.  The 65-year-old grandmother from Pennsylvania had a meningioma, which occurs in the lining of the brain. It caused her brain to swell, leading to seizures and balance issues.  After a failed attempt to remove the tumor, she turned to the Internet for help, and that's when she came across two doctors at Johns Hopkins Hospital who were performing brain surgery through the eyelid.   (Johns Hopkins Hospital)

Those two doctors were facial plastic and reconstructive surgeon, Dr. Kofi Boahene, and neurosurgeon, Dr. Alfredo Quinones-Hinojosa. Together, they helped to pioneer the ground-breaking surgery known as a transpalpebral orbitofrontal craniotomy.  "Going through the eyelid offers a simpler, more direct route to the middle and front regions of the brain than traditional skull-based surgery," Boahene said. "This minimally invasive approach also avoids the major head trauma typically associated with brain surgery."   (Johns Hopkins Hospital)

Before the procedure, the surgeons drew along Byrnes' eyelid with a black marker, making sure the line would not visible when she opened her eyes. “For this approach, the major benefit that I see to the patient is the fact that instead of going through an incision from ear to ear, now we can go right here,” Quinones-Hinojosa, said, pointing to his own eyelid, “and get this brain tumor out.” That means, instead of shaving the patients' head, opening the top half of the skull and moving aside whole outer sections of the brain, surgeons make a tiny incision through the eyelid creases and remove a small section of the skull bone right above the eyebrow to reach the tumor. The skull bone is later replaced.     (Johns Hopkins Hospitall)

Boahene, seen here scrubbing in before the surgery, said this procedure also cuts down on the time in the operating room. Instead of the traditional four to eight hours, this new approach only takes around two hours. Boahene, an assistant professor at the Johns Hopkins University School of Medicine, has performed at least a dozen of these surgeries since 2007.   (Johns Hopkins Hospital)

After a few hours of preoperative care, Byrnes, who is the 19th person to ever undergo this procedure, was wheeled on a stretcher into the OR, where surgeons operated on her for approximately two hours. “The biggest risk is for scarring and infection,” Boahene said. “But that is very minimal. Most patients have swelling around their eyelids. We treat it with ice and usually within three days, it's back to normal.” (Johns Hopkins Hospital)

“In the end,” Boahene added, “the patient is going to be left with an incision that's in the eye crease. When they open their eyes, and they're talking to you, you won't see it. And then there will be no long-lasting effects that they had this big brain surgery.” Following the surgery, the doctors told Byrnes she could expect some discomfort, discoloration, swelling, and ultimately - a cure.   (Johns Hopkins Hospital)

This photo looks pretty bad, but five hours after she went into pre-ops, Byrnes was wheeled back out of the operating room and sent to intensive care. Quinones and Boahene came out to speak to her family. “Everything went great,” Quinones said, shaking their hands. “Everything went really, really well.” Things went so well, Byrnes was discharged from the hospital two days after the surgery. She is now recuperating at her daughter’s house. “She hasn’t had any seizures at all and the only thing she’s taking for pain is Tylenol,” said her daughter, Maria Shaffer. “It’s absolutely amazing – she’s doing phenomenal. She’s even playing cards with the grand-kids.” (Johns Hopkins Hospital)