June - ENT and Neurosurgery Team Up


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Every sunrise helps June help others

When common symptoms turned into a complex diagnosis for June, finding the expertise she needed became critical. A local, dedicated care team representing nine different specialties treated June’s skull-based tumor and helped her get back to what matters to her most – family, friends and her work as a parish nurse serving the homeless in Minneapolis.


Routine surgery reveals rare condition

When June was suffering from persistent sinus issues, her doctor recommended routine surgery. But the situation turned anything but routine when the surgery revealed a new problem: she was diagnosed with esthesioneuroblastoma, a rare tumor of the sinus cavity, and a walnut-sized tumor in her brain.

As a nurse, June has advised many patients not to jump to the worst-case scenario, but she found it hard to follow that advice herself. The diagnosis was life-changing, and would require uncommon expertise for treatment. Traditional surgery would require opening her skull to get to the tumors, but her ENT surgeon directed her to a specialist at the University of Minnesota who could perform a minimally invasive endoscopic procedure through the nasal cavity.

That physician is Dr. Emiro Caicedo-Granados, an otolaryngologist and head and neck surgeon. He and neurosurgeon Ramachandra Tummala, MD, collaborate in a skull-base tumor clinic, which allowed June to see both physicians in one appointment and provided multi-specialty expertise for her complex condition. This collaboration also includes physicians from oncology and radiation oncology who all work together to develop a care plan for each patient.

June was immediately put at ease by their teamwork, their warmth and their sense of humor. “They do research and are excellent scientists, but were warm and caring,” she says. “I felt secure.” There was a lot of information to process at that first appointment, but June says, “I realized right away that they would talk to me one-on-one, that who I am is more important than my tumor.” Care coordinator Jennifer Jankovic was available to provide context, answer questions, order medications and calm June’s anxiety. With care needed in the ENT, neurosurgery, dental, dysphasia, infusion, swallow, ophthalmology, radiation and anesthesia clinics, Jennifer was able to coordinate appointments so June could minimize her trips to campus both before surgery and for her follow-up care.

The power of collaboration

June’s family was welcomed and included in discussions as important members of her team. Teamwork is important to Dr. Caicedo-Granados. “It starts with the first phone call from the referring physician. The person who answers that call knows exactly where that patient should go and what is needed. People come to see me or Dr. Tummala, but behind us is this great team that makes everything go. We couldn’t do it without them.” Medical students and residents add to the quality of care as well. “They keep the physicians willing to improve every day and learn more,” he says.

Before the first appointment, the team gathers lab and imaging results and the physicians consult with other specialists here; at the first meeting with a patient they often already have a treatment plan ready. By working with colleagues across departments, Dr. Caicedo-Granados says, “We make sure the imaging is correct, the pathology is correct, we’re not missing anything. That all options have been considered.”

June’s journey continues

Finally the day arrived and June’s ten-hour surgery began. Staff updated her family in the waiting room every hour. When the operation was over, the surgeons emerged with good news: the sinus tumor was malignant but the brain tumor was benign. June would make a full recovery.

June spent four days recovering in the hospital, about half the time that would have been required with traditional surgery, then had six weeks of radiation treatment. Her follow-up care will continue for up to ten years, to ensure any returning malignancy is caught early.

Reflecting on her journey, June says, “One of my greatest comforts is the security I have in the care that was provided. A path had been laid before me and I had an expert team to guide me through.”

That path traveled, June was able to return to helping others. “I haven’t saved the world yet,” she says.” There are still homeless people in downtown Minneapolis. The best has been done to help me. Now I have things I need to do.”


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