The new Pituitary and Skull Base Surgery Center at Cincinnati Children’s brings together an experienced, dedicated team of pediatric neurosurgeons, otolaryngologists and plastic surgeons who are passionate about providing exceptional care for children with rare conditions of the skull base.

The comprehensive program provides treatment for craniopharyngioma, dermoid cyst, pituitary tumors, meningiomas, chordomas and other skull base conditions. During the initial evaluation, the child sees two to three specialists (depending on their needs) in one location. The team provides a unified treatment recommendation, often on the same day. When appropriate, the team may ask other specialists at Cincinnati Children’s—such as pediatric oncologists, ophthalmologists or endocrinologists—to be part of the child’s care team either before or after surgical consultation.

“We want to be a one-stop shop for these patients and provide personalized, timely care,” says Smruti Patel, MD, co-director of the center. “If we decide during the first appointment that a child needs additional labs or advanced imaging, we can expedite those quickly and conveniently to help families avoid multiple visits over weeks or months.”

An All-Pediatrics Care Team

The center is one of only a few pituitary and skull base surgery centers in the country that is exclusively staffed by pediatric specialists. “Other institutions may have just one or two pediatric skull base specialists and fill any gaps with adult care providers,” says Alessandro de Alarcon, MD, MPH, a pediatric otolaryngologist who sees patients at the center. “Coming here, you have a group of people with a high level of expertise who know how these conditions present in kids and offer techniques that are well-suited to the pediatric population. Everything a patient needs is conveniently located under one roof in a kid-friendly environment.”

A Novel Technique for Nasal Dermoid Cyst Resection

Larger lesions typically require an open surgery, but the team uses minimally invasive surgical techniques for resection and reconstruction whenever possible. For example, resecting nasal dermoid cysts is uniquely challenging due to the cysts’ location and unusual barbell shape. Most centers use an open approach, which involves an ear-to-ear incision, removal of part of the skull and dissection of muscle at the side of the head.

For the past five years, pediatric neurosurgeons at Cincinnati Children’s have used an endoscopic approach. It results in less swelling and scarring and a lower risk of infection and cerebrospinal fluid leakage, with outcomes that are on par with open surgery.

“We remove the nasal portion of the cyst and, after dissecting the nasal cartilage underneath, access the rest of the cyst endoscopically,” says pediatric neurosurgeon Jesse Skoch, MD. “After endoscopic resection, our plastic surgeon reconstructs the nasal cartilage. So instead of a large incision on the scalp, there’s just one small incision. Patients are usually discharged the next day with almost no swelling. This technique is a game-changer for children with nasal dermoid cysts—families are thrilled not to have to undergo invasive cranial surgery.”

Skoch adds that pediatric otolaryngologists and plastic surgeons play a critical role in these surgeries. They plan complex skull base surgeries with the pediatric neurosurgeons and work side-by-side with them in our dedicated “BrainSUITE,” an operating room equipped with highly specialized equipment that helps surgeons be more precise in locating and removing skull base tumors.

Access to Proton Therapy for Children with Cancer

A small percentage of children are diagnosed with neoplastic skull base tumors, and in some situations, proton therapy is part of their comprehensive treatment plan. Proton therapy uses pencil beam scanning technology to destroy cancer cells while minimizing damage to healthy organs and tissue. It is one of the most precise and advanced forms of radiation therapy available in the world today. The Proton Therapy Center at Cincinnati Children’s is one of only two such centers in the world owned by a children’s hospital.

To learn more about the Pituitary and Skull Base Surgery Center at Cincinnati Children’s or refer a patient, contact Liz Downing, coordinator.