If there was ever a mantra for the cranial-base surgeons at Roosevelt Hospital, it's that there's no such thing as an °operation "going as planned." This was the case two weeks ago when Dr. Peter Costantino and Dr. Chandranath Sen spent over seven hours successfully removing a trigeminal neuroma (a type of tumor) from behind the right eye of 14-year-old Jessica Saunders, overcoming periods of bleeding and other obstacles.

For years, the Albany girl had gone from one doctor to another, all of whom had repeatedly misdiagnosed her blurred vision. "We were being bounced around like a basketball," said Polly Saunders, Jessica's mother. But an MRI this summer finally revealed the culprit: Jessica had a massive tumor behind her right eye.

Polly and her husband Rick soon learned their daughter's tumor, though thankfully benign, was in a precarious °location. The neuroma was attached to the optic nerve, and also pushing against the temporal lobe of Jessica's brain and her carotid artery.

Operating to remove the tumor could completely destroy the already damaged optic nerve. But if ignored further, the °tumor would continue to grow. "Over a °period of several months to years, it would actually kill her," said Costantino.

Jessica's doctors in Albany decided the operation was out of their league and sent her to see Sen and Costantino earlier this fall. Co-directors at Roosevelt's Center for Cranial Base Surgery, the surgeons are among the few doctors nationwide with experience removing such °tumors endoscopically.

With the Daily News joining them in the OR, the surgeons fed endoscopic cameras and instruments through Jessica's right nostril — as many as four lines at a time — to first open up the nasal cavity and °sinuses, gaining access to the bottom of the tumor. They also used a computerized 3-D navigational device that mapped how far they had progressed into the tissue.

"We're going to debulk it from the center so we get an intact perimeter," Costantino reported as he cauterized nasal tissue surrounding the tumor. "The key is that it holds on the other side."

Sen, the hospital's neurosurgery chairman, has performed tumor removals with Costantino using both open and endoscopic techniques for 15 years now. Sen let his colleague get started, watching from the side, and then eventually joined in. Progress was tediously slow, the surgeons moving the instruments with their eyes glued to the monitors displaying the endoscope's image. "See that shell? The carotid is right in there," said Costantino at one point.

"Let me see the navigator," replied Sen, inserting the tip of the mapping stick, which, displayed on an adjacent computer screen, showed a diagram of Jessica's head.

The team soon elected to cut through Jessica's upper lip. "The piece behind the eyeball is hard to see. We want to come up from the lip to see the front of the tumor," explained Sen. Bleeding ensued at various points as tumor bits were removed. "There are blood vessels compressed by the tumor," said Sen. "You remove it and this is what happens."

But the surgeons couldn't stop the bleeding naturally at one point. After 30 minutes and a few units of Jessica's own blood were used, the doctors elected to use a drug known as Factor VII, which stimulates coagulation — at a cost of $5,000-$8,000 per dose.

TITANIUM TO THE RESCUE
With that behind them, one final issue cropped up. Part of Jessica's eye socket had been "half filled by this tumor and kind of fell in," said Sen. A titanium mesh plate was inserted in the orbit to prop up her eye. Despite all the variables in play, the goal of getting all the tumor out was achieved. "It went very well," said Costantino afterward. "Her optic nerve and eye are now safe."

A day later, Jessica's right-eye vision was better than before the surgery, and she was already up and walking around the hospital. A post-op MRI found no traces of the tumor left behind.

"They're miracle performers, I feel very grateful," said Polly Saunders of Sen and Costantino. "There's nothing I can ever do or say to explain what I feel for what they've done for her."