It was the first surgery of its kind in the history of medical science.
A tumor that might or might not be the remains of an undeveloped sibling attached to a patient since before birth was recently extracted by Los Angeles doctor Hrayr K. Shahinian via a process he calls minimally invasive endoscopy.
The subject of the procedure, computer science Ph.D. student Yamini Karanam, called the tumor her “evil twin sister.” The teratoma found nestled in her brain matter had bones, hair and teeth. “It was ugly,” Shahinian said.
The doctor is known for pioneering his rare “keyhole” surgery to extract tumors without undergoing what he calls a “barbaric procedure” to saw off the top of one's skull. He burrows into natural brain pathways and uses a tiny video camera to track his progress.
He told us this week that this was the “first time in the history of mankind that a teratoma in the deepest part of the brain has been taken out endoscopically.”
“It's even a first for me,” he said, “and I'm the one who devised this technique.”
Karanam, who traveled to L.A. from Indian to undergo the procedure, isn't done with the episode just yet.
Shahinian, who performed the surgery at the Skull Base Institute near Cedars Sinai Medical Center, said Karanam will have to undergo MRI brain scans occasionally for five years.
“This young lady was literally slowly dying,” he said. “She had seen many surgeons, and nobody wanted to touch this thing because it was so dangerous and so deep.”
But was it really a long lost twin? The science is still out on that, Shahinian said:
I don't think we know for sure. My opinion is that there is not enough hard scientific evidence one way or another. It is a germ cell tumor, so it does come from the same germ cells that create the embryo.
Karanam said she suffered from headaches, pain, crippling fatigue and missed work days in the months before her surgery. Doctors originally thought she had a cyst, she said, but they wouldn't connect its presence to her suffering.
She started a Giveforward crowdfunding campaign that more than paid for Shahinian's work.
Last week a friend updated the crowdfunding project to say the surgery was a success, a twin was discovered, and that Karanam “is healthy and in a less painful situation.”
It seems clear that humor helped her get through it all. The good doctor says that when Karanam first called the tumor her “evil twin sister” he “started laughing uncontrollably.”
“It wasn't evil because it turned out to be benign,” he said. “I'm thrilled for the outcome. It could have been a lot worse.”