Children’s Hospital Boston’s interdisciplinary Center for Head, Neck and Skull Base offers minimally invasive approaches to treating conditions of the brain and skull base through the use of endoscopy. This method removes the need for any visible incision, results in a faster recovery, significantly reduces discomfort and has a markedly improved cosmetic outcome. While many of these techniques were initially used in adults, Children’s has become a national leader in using these approaches in children.
The team is made up of specialists from Otolaryngology, Neurosurgery, Plastic Surgery, Medical and Radiation Oncology, General Surgery, Pathology, Radiology, Nursing and Social Work. This interdisciplinary approach enables the Skull Base team to successfully treat difficult conditions that might be impossible for any one specialist to fix alone.
Using combinations of open surgery, microsurgery and minimally invasive techniques such as endoscopy, the team can treat most head, neck or skull base conditions. For example, the team can remove complex tumors of the pituitary gland, repair congenital defects like holes in the skull (nasal encephaloceles and nasal gliomas) and cure developmental problems, such as transnasal dermoids. It has also had success with removing juvenile nasopharyngeal angiofibromas without any external facial incisions
Edward Laws, MD, a neurosurgeon at Children’s and director of the Pituitary/Neuroendocrine Center at Brigham and Women’s Hospital, has performed more than 5,000 transsphenoidal surgeries for pituitary tumors on adult patients. Dr. Laws has been instrumental in working with Edward Smith, MD, staff neurosurgeon at Children’s, in translating a new endoscopic technique for this approach from adults to children.
Whereas doctors once had to regularly perform a craniotomy to remove even the smallest skull base tumors, surgeons at the center use endoscopic tools to make tiny incisions within the nostril and remove tumors through pea-sized openings in the bone. This kind of operation avoids any visible scarring, is considerably faster to perform and creates far less discomfort for patients—all resulting in an easier, shorter hospital stay.
Using a technology called frameless stereotaxy, in which preoperative images (such as MRI or CT) are loaded onto a special computer, surgeons can clearly identify the location of the problem to be fixed. Like using a GPS, the team can navigate the safest route to the problem, such as an encephalocoele or tumor, with real-time 3-D images, leaving the healthy tissue nearby intact and undisturbed.
Many of the team’s physicians are engaged in research directed at advancing the field. Dr. Smith is currently working with Marsha Moses, PhD, director of the Vascular Biology Program at Children’s, on the development of a urine test to non-invasively detect and monitor tumors so that growths can be identified at an early stage and treated more effectively.
Depending on the condition, new patients may be referred to
multiple specialists. After the initial visit, members of the team will meet to plan the best possible treatment for each individual.
Make a referral: 617-355-1990
Edward Laws, MD, FACS Neurosurgeon, Department of Neurosurgery
John Meara, MD, DMD, MBA Plastic Surgeon-in-Chief, Department of Plastic Surgery
Reza Rahbar, MD, DMD, FACS Surgeon, Department of Otolaryngology
Edward Smith, MD, FAAP Neurosurgeon, Department of Neurosurgery