Major Jagatkumar Patel, an Indian American surgeon serving in the US Army, has developed an innovative minimally invasive technique to remove brain tumours without opening the skull — instead operating entirely through the nasal passages. The procedure, credited to Patel and his neurosurgical partner, is drawing attention from the Pentagon as a potential advance in military and civilian neurosurgery.

How the Procedure Works

The technique involves navigating through the nose to reach tumours at the base of the skull — a region historically accessible only through open cranial surgery. Patel developed a detailed plan to map the complex nasal anatomy and create a clear surgical corridor.

During the operation, Patel uses an endoscopic camera to deliver high-definition, close-up visualisation of the tumour on a surgical monitor, allowing his colleague to dissect and extract the growth with precision. 'If he needs to get to critical structures, I can drive the camera closer, so he has perfect visualisation,' Patel said.

'Historically, most of these surgeries were done open, which is a much more challenging procedure for the patient,' Patel noted. 'Today, if a tumour is the appropriate size and location, open surgery just isn't necessary. Through the nose, we get the best access and the best chance of complete removal.'

The Patient: A Marine's 15-Year Battle

The procedure was recently performed on Marine Staff Sergeant Andy Archer, who had endured severe headaches for 15 years. When he developed vision problems, an MRI scan revealed a tumour approximately the size of a golf ball — measuring 4.4 centimetres — positioned in front of the pituitary gland and pressing against the optic nerve.

Archer was transferred to Walter Reed Army National Medical Centre, the premier military health facility in Bethesda, where Patel and Lieutenant Colonel Charles Miller performed the minimally invasive transnasal procedure to extract the tumour entirely.

Recovery and Outcomes

Just two days after surgery, Archer showed no visible external signs of having undergone a major brain operation. He was already sitting up in the surgical intensive care unit, and his vision had begun to clear — a recovery trajectory that would have been significantly longer with conventional open surgery.

Patel was quick to attribute the success to teamwork. 'My skills in navigating the nasal approach are only useful because he is skilled enough to completely remove the tumour once we get there,' he said, referring to Miller. 'It is a true team effort.'

Significance Within Military Medicine

'I don't think anyone else in the Defense Health Agency has this kind of team performing these complex skull base surgeries,' Patel said. He also acknowledged the procedure's limitations: the tumour must be of a specific size and located in a position accessible through the nasal route. 'A minimally invasive approach through the nasal passages is more challenging and we are mindful that the tumour has to be in a certain spot to go through the nose,' he added.

The technique represents a meaningful departure from standard neurosurgical practice and could set a precedent for how skull-base tumours are treated within the US military health system going forward.