Removing tumours at the base of the skull used to involve removing part of the skull and exposing the brain. Now, it can be done without a single cut.

In a new, minimally invasive surgical approach, a team at Sydney Children’s Hospital, Randwick (SCH) are using the nasal cavity as a passage to access the base of the skull and remove tumours, helping to significantly reduce pain and improve recovery times for children.  

The approach, referred to as the Base of Skull Service (BOSS), is one of the first integrated paediatric multidisciplinary skull base unit in the southern hemisphere and has been game-changing for patients like eight-year-old Issac.  

Issac was diagnosed with craniopharyngioma when he was five years old. The condition causes benign tumours to grow in the central nervous system – the area of the brain that controls the ability to see, hear, smell, taste, talk, swallow and move, as well as the vessels that supply blood to the brain.  

Issac has already undergone two craniotomies, a major surgery where part of the skull is temporarily removed, to shrink the brain tumour but in recent months, it had grown back at a rapid rate.

With the tumour blocking fluid to Issac’s brain and causing him severe nausea and headaches, surgery was essential but this time, the team decided there was a better way.

Led by Dr Catherine Banks, Ear, Nose and Throat Surgeon at SCH, the team would use highly specialised, precision equipment, including the StealthStation, to delicately drill away the bone between Issac’s nose and the base of his skull to expose the tumour and give neurosurgeon, Dr Jacob Fairhall, the access he needed to remove it.

The surgery was complex, and planning was essential so with the help of the Tyree Institute of Health Engineering at UNSW, an exact replica of Issac’s brain was 3D printed, enabling surgeons to pinpoint the location of the tumour and visualise how they were going to access it.

When surgery day came, Issac was nervous but remained stoic, reassuring his mum that when he woke up, everything would be ok - and he was right. The surgery was a success and after the mammoth 11-hour operation, there were no more signs of the tumour.

“Visually, to the naked eye, you couldn’t see any tumour at all. When you look at the scan it’s clean,” Issac’s mum, Karol, said.  

“All the doctors and nurses were so thrilled, we were thrilled. It’s an amazing result.”

Dr Banks said the surgery and Issac’s recovery was testament to the multidisciplinary team, compromising of more than 20 different experts, and shows how vital the BOSS service is.

“It’s actually amazing how well he is doing. I went in and saw him the very next morning [after his operation] and he was awake, gave me the thumbs-up, even with the ventilation tube in,” Dr Banks said.

“Then I walked past one day and he was sitting up in the ICU doing a Rubik’s cube in 36 seconds.”

Three weeks on, Issac is not just back home, but back at school with no pain and no wounds to show for his surgery. There is a chance the tumour will return but with the ability to manage his condition endoscopically through BOSS, Issac’s life can continue as normal.  

The Base of Skull Service is proudly supported by Sydney Children’s Hospital’s Foundation, who have contributed more than $2 million over three years to fast-track this transformative care.