For the first time in the history of Health Department Kashmir, Angiofibroma surgery—a procedure to remove a benign tumor composed of blood vessels and connective tissue—has been successfully conducted at Jawahar Lal Nehru Memorial (JLNM) Hospital, Rainawari, Srinagar. Previously performed only in tertiary care hospitals, this breakthrough sets a new benchmark for peripheral healthcare services in the region. To delve into the details of this ground breaking procedure and its impact on healthcare, Rising Kashmir’s senior health correspondent, M Peerzada, spoke with Dr Shafqat Islam, senior consultant and head of the ENT department at JLNM Hospital Rainawari. Dr Islam, an AIRS Gold Medalist (2013), National Operating Faculty for SeptoRhinoplasty, and a core committee member of the Rhinoplasty Governing Body and Editorial Board of FRCSIT, shared insights on the procedure and its potential to advance treatment options in the valley.
Excerpts:
What is Angiofibroma?
Nasal angiofibroma, also known as juvenile nasopharyngeal angiofibroma (JNA), is a benign locally aggressive, vascular tumour that grows in the nasal cavity and can spread to other parts of the head. It is made up of blood vessels that stem from the carotid artery.
It can extend from the nasal cavity to the sinuses, eye socket, skull, and brain. It presents typically with epistaxis, obstructive symptoms, and chronic otomastoiditis. The examination of this tumour reveals pale reddish-blue mass. The treatment of choice is usually surgical resection; either open or endoscopic.
Can you share details about the first angiofibroma surgery performed at the JLNM hospital?
First time such a surgery has been performed within the Health Department, setting a new benchmark in peripheral healthcare services. The ground breaking procedure involved the complete endoscopic clearance of a Fischer 3A angiofibroma, a tumor known for its severe bleeding and nasal obstruction. It is typically treated only in tertiary care hospitals here.
The operating team comprised Dr Omer Shafi, Dr Mudasir ul Islam, and Dr Neelam, along with the anaesthesia team, including Dr Arifa, Dr Manzoor, and Dr Akib. They were assisted by Samiullah, Bashir Ahmed, and Muneer Ahmad.
What were the key challenges involved in treating this case of angiofibroma?
Challenges in surgical treatment of JA include control of intraoperative bleeding, addressing the different routes of skull base spread of the tumor and preventing morbidity. Intraoperative haemorrhage is the hallmark of surgical treatment of large JAs. A surgical approach should provide adequate visualization in the surgical field as well as early control of vascular supply. JA develops in a deep narrow space, namely, the Pterogopalantine fossa.
What steps were taken to ensure the success of the surgery, and what makes this particular surgery stand out?
A multidisciplinary approach for evaluation and care of these patients maximizes the best outcome. Once a presumptive diagnosis was established, precise evaluation of imaging is crucial for resection planning. CECT angiography was necessary to assess tumor extension and provide intraoperative image guidance.
Biopsy should not be performed as this will lead to excess bleeding.
Staging system: Tumour staging was done as it demonstrates stronger correlation with intraoperative blood loss and the need for multiple surgeries (staged, residual, or recurrent tumor).
Can you describe the patient’s condition and progress after the surgery?
Perioperative care: Because of the serious nature of this surgery, all patients should have an evaluation and clearance from their anaesthesiologist. Preoperative labs including a complete blood count, coagulation assessment, and chemistry should be obtained. All patients should be typed and cross matched for blood products. Often, 2 units of blood products are kept in the room in case rapid bleeding ensues. Coagulation factors such as fresh frozen plasma should also be available.
In the preoperative stage, the patient had nasal obstruction and recurrent episodes of bleeding nose with anaemia and post-surgery patient is fine and recovering fast.
What advice would you give to other medical professionals or institutions based on your experience with this case?
As a surgeon, we should be committed to refining our skills through rigorous training, mentorship and hands-on experience. With each successful procedure, we grow more confident and driven to deliver exceptional patient care and outcomes.
How does this achievement contribute to advancement of ENT care? What impact will this surgery have on future cases of angiofibroma in your department?
The achievements of our team reflect the remarkable growth and progress of our hospital, demonstrating our collective commitment to delivering good healthcare services.
How do you think this success reflects overall growth and capabilities of JLNM Hospital in terms of advanced medical treatments?
As we celebrate our successes, we acknowledge the efforts put by the Director, Health Services Kashmir, Dr Jahangir Bakshi, Medical Superintendent JLNM Hospital, Dr Tariq Jan and Administrative Department for constant support and encouragement in the tremendous growth of our hospital and dedication to improving lives.
