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New brain surgery simplifies osteoma treatment

A stockbroker from Fort Salonga, Tony Suttora found the riskiest business wasn't on Wall Street. An innovative brain surgery called single-stage cranial implant surgery helped treat a nonmalignant skull tumor.

As Tony Suttora, 57, looks in the mirror in the morning while getting ready for work, he smiles and then recalls that just a short year ago, things were very different.

Mr. Suttora, a stockbroker from Fort Salonga, is one of the first patients at Huntington Hospital to benefit from single-stage custom cranial implant surgery to treat a nonmalignant skull tumor called an osteoma.

Diagnosing the osteoma

Mr. Suttora's story goes back 26 years, when as a much younger man, he noticed a painful lump on his forehead. As the lump grew steadily and became more obvious to others, he sought medical evaluation and ultimately, had the mass removed without difficulty by a cosmetic surgeon. The diagnosis of a benign osteoma was good news, and surgical removal is usually curative. However, in 2016, Mr. Suttora began to have headaches and pain again. In less than a year, a mass had grown back to about the size of a golf ball.

He was referred to a neurosurgeon, Robert Kerr, MD, PhD, chief of neurosurgery at Huntington Hospital, who has extensive experience in skull-base and brain tumor surgery. Dr. Kerr is the first on Long Island to employ the single-stage custom cranial implant surgery.

"In this situation, we were concerned that we were dealing with a more malignant pathology because the tumor was painful and had grown so rapidly," said Dr. Kerr. The objective of surgery had to be complete removal of the mass that was expanding both outward, under the scalp, and inward, compressing the brain.

Dr. Kerr went on to explain, "Traditionally, to treat an osteoma (or other skull lesion), a two-stage approach was required. The first stage was to perform a craniectomy to completely excise a skull-infiltrating tumor with clear (disease-free) margins. Following surgery, a high-quality computed tomography (CT) scan would be performed and 3D computer modeling used to generate a custom prosthetic. Once the patient had healed from surgery, the patient would return to the operating room for a second procedure to implant the cranial prosthetic."

3D printer models create personalized implant

However, now Dr. Kerr is working with the engineering team at Stryker Medical to generate a personalized implant using 3D printing and titanium molding techniques. Both magnetic resonance imaging (MRI) scans and CT scans are used to create 3D virtual models of the patient's brain and skull. Dr. Kerr then works remotely via computer in real time with the engineering team in Malvern, PA, to perform a simulated surgical resection.

The Stryker engineers use the simulation to generate a 3D printed model of the surgical excision, a 3D printed titanium mold, and then a custom high-density porous polyethylene prosthetic that is specific to each patient. Once the prosthetic is made, the patient is scheduled for single-stage surgery so that Dr. Kerr can remove the tumor and implant the prosthetic, all in one procedure.

"Being able to perform a craniectomy and implantation all in one step is very beneficial to the patient," said Dr. Kerr. "Not only can the patient have the tumor removed and the prosthetic implanted in one operation rather than two, but it allows for a much quicker recovery time and better healing and appearance of the incision line. We are very fortunate to have access to this incredible technology and engineering for our patients in Huntington and this region. We have performed six cases using this method over the last two years."

"Having the excision of the tumor and the prosthetic placement performed as one procedure was undoubtedly the right decision," said Mr. Suttora. "After years of self-consciousness about the exposed tumor, I have regained confidence around friends and colleagues. Many of my peers and family members are still amazed at the before-and-after pictures. I am extremely appreciative of Dr. Kerr, his staff and Huntington Hospital personnel for their tremendous care and professionalism before and after the surgery."

For more information about the advanced neurosurgery treatments available, contact the Surgical Specialty Center:
(631) 351-4840
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