Cranial Base Program

The cranial base includes the lower part of your child’s skull that sits on their spine and the areas just above their eyes and behind their face. Lesions in this part of the head may need to be removed because they might cause problems with nearby tissues, like the bones, brain, ears, eyes or cranial nerves. 

In the past, surgeons could not safely get to some areas of the cranial base at all, or they could get there only by making large incisions and removing part of the skull. This often meant longer hospital stays. Sometimes this is still the best way to reach the area surgeons need to get to.

With advanced minimally invasive procedures, now we can reach the cranial base through other paths. We might enter:

• Through your child’s nose
• Through your child’s mouth
• Alongside your child’s eye
• Through a small opening made in the bone near their eyebrow

Using methods like these, surgeons don’t have to disturb as much of your child’s healthy tissue to reach a problem area. This often means a small scar or no visible scar, fewer side effects and faster recovery.

• The members of your Cranial Base care team are chosen to meet your child’s unique needs. Most patients see experts from both Otolaryngology and Neurosurgery. Your child might also see doctors and surgeons from Endocrinology, Interventional Radiology, Ophthalmology and oculoplastics and the Vascular Anomalies Program. If needed, we will involve other Seattle Children’s specialists, like facial plastic surgeons, neuroradiologists, pediatricians, hematologists-oncologists and radiation oncologists.
• Some adult hospitals do cranial base surgery for both adults and kids. Here we specialize in taking care of children – before, during and after their surgery. We have adapted surgery techniques created for adults so we can provide the best care for young patients, who are smaller and still developing.
• If your child needs more than 1 procedure, like embolization by an interventional radiologist and surgery by a head and neck surgeon, we combine these whenever we can. This is safer and easier for your child because they are only under anesthesia once and they go through a single recovery.
• Seattle Children’s has an experienced team of anesthesiologists with special training in giving anesthesia to children.
• After cranial base surgery, many children spend 1 night in our Pediatric Intensive Care Unit (PICU) before going home. In the PICU, your child receives care from doctors and nurses who are certified in pediatric critical care medicine.

• Every child is different. It takes highly technical planning for doctors to figure out the safest and most effective way to treat your child’s lesion or tumor with the lowest risk. Our team has the knowledge and experience to do this planning. We consider all the options before we recommend a custom-made treatment plan.
• We use the latest software to carefully look at imaging studies, like CT (computed tomography) scans and MRI (magnetic resonance imaging) scans, to understand the details of your child’s anatomy. With this software, we can compare digital models of different paths to choose the best one.
• Surgical planning might include 3D printing a model of your child’s head or using virtual reality software to explore different surgical paths. These methods help us fully prepare for complex surgeries.
• Members of the Cranial Base team plan your child’s treatment as a group so you get the team’s combined expertise. Based on your child’s condition, we might also talk about their care at Tumor Board, a special meeting of Seattle Children’s tumor experts.

• We hold Cranial Base Clinic once a month. If your child needs to be seen sooner, we can arrange a visit for you between our scheduled clinics.
• To provide care that’s easier on you, we bring doctors together to see your child on the same day. We can also coordinate imaging tests before your first visit so we have the results when you come in.
• Families travel from around the country to see our Cranial Base team. Seattle Children’s is experienced in supporting families who come from outside the area to get treatment here.

• Our surgeons work with a team of head and neck surgeons and engineers at the University of Washington BioRobotics Lab to develop new, more powerful software to plan, guide and analyze cranial base surgery.
• A main focus of our research is figuring out the right surgery for each child’s anatomy and lesion. We study how to use planning software to look at every option so your surgeon can choose the best one.
• During cranial base surgery, software tracks the tip of the surgical tool and combines the data with your child’s CT scans. This lets surgeons see exactly where the tool is as they work. We’re developing the next generation of this technology. It will alert surgeons if they start to go off the planned path even slightly.
• After surgery, we study our results. This includes checking whether the surgeon followed the plan exactly or made changes. Research like this helps us refine our surgical plans.
• Cranial base tumors and lesions in children are rare. To help doctors understand why they happen, you have the option to take part in our biorepository. This means doctors keep a tiny sample of the tissue we removed. Genetic tests of the tissue may provide clues that help us treat other children in the future.

Cerebrospinal fluid (CSF) may leak if a hole forms in the meninges. Causes may include a head injury or tumor. Sometimes a leak happens for no known reason. Many leaks heal with rest. Some need to be repaired with surgery.

This is a cyst that can form in part of your child’s skull (temporal bone) near their middle ear. Without treatment, the cyst can grow, damage bone and nerves and affect your child’s hearing.

This benign tumor forms in the middle of the head behind the eyes. This is near the pituitary gland. Even though it isn’t cancer, it needs to be treated because it can affect the pituitary, the nerve between the eye and brain (optic nerve) or other parts nearby.

This type of cancer starts in the nerve that detects smell (olfactory nerve). It is close to the upper nose and front of the skull. It can block your child’s nose, affect their sense of smell, cause nosebleeds and headaches, affect vision and cause other symptoms. Treatment is usually surgery to remove the tumor.

Glomus tumors usually form in the fingers, but they can form in other parts of the body, including the head and neck. They may be in or near the middle ear, near a large neck vein (jugular vein) just below the middle ear or deep in the neck along a nerve. This nerve (vagus nerve) goes from the brain into the trunk. Glomus tumors are not cancer, but it’s important to remove them because they can damage nearby tissues.

Angiofibromas are benign tumors made of blood vessels. In children, they usually happen in the nose or upper throat (nasopharynx). Although these tumors aren’t cancer, they can grow and spread to affect other parts of your child’s face or head, like their brain and cranial nerves.

Often a dermoid cyst is a simple cyst under the skin. But a nasal dermoid can be complex with many “pockets” that extend deep into the head. Imaging tests will help your child’s care team understand the size, shape and location of your child’s nasal dermoid and reach all parts of it.

Orbital tumors are abnormal growths in the eye socket (also called the orbit). They can affect the eyelid, the eye itself or tissues behind the eye. There are many types of orbital tumors that form from different kinds of tissue, such as bone (osteomas), blood or lymph vessels (hemangiomas, venous malformations, lymphangiomas or lymphatic malformations) and fat or muscle (sarcomas). Orbital tumors can be either benign or cancerous. Even if the tumor is benign, your child might need surgery to remove the tumor and protect their vision and other parts of their face and head.

This tumor starts in the pituitary gland and is usually benign. It can grow large enough to press on things nearby, like the brain or optic nerves. It can also keep your child’s pituitary gland from working normally. The pituitary gland releases hormones that control many other glands, affecting how your child grows and develops.

Your child has several sinuses in the middle of their face and head around their nose (paranasal sinuses). They are:

• In the forehead above the nose (frontal sinuses)
• Between the eyes (ethmoid sinuses)
• In the cheeks (maxillary sinuses)
• Deep behind the nose between the eyes (sphenoid sinuses)

The lining inside paranasal sinuses makes mucus. Cancer can develop from cells in this lining or from the bone, cartilage or other tissues in the area. Surgery to remove the tumor is a main treatment for paranasal tumors.

These tumors start from special cells that wrap and protect nerves (Schwann cells). Schwannomas can form around any nerve, including cranial nerves. Usually they are benign, but they can cause serious symptoms by pressing on nerves or other structures in the area, so they may need to be taken out.

Some of the many other conditions we treat in the Cranial Base Program include epidermoids, inverted papillomas, meningiomas, neurofibromas and tumors in bone or cartilage (such as chondromas, chondrosarcomas, chordomas and tumors of the temporal bones).

The surgeon passes a thin endoscope and small surgical tools into your child’s nostrils and through your child’s nose to remove a lesion in or near the nose or deeper in the head. There is no need for an incision in your child’s face.

Surgeons reach areas in or around the eye socket or deeper in the head behind the socket by passing small instruments between your child’s eye and the bone around the eye. Your child will have a small incision next to their eye or in their eyelid, where natural folds in the skin can hide the small scar.

By going through your child’s mouth, surgeons can reach and remove some cranial base lesions without having to make incisions that can be seen in your child’s face. This is the most direct route to some parts of the head.

This type of surgery is a form of radiation therapy used to treat conditions inside the head. It does not require skin incisions or openings in your child’s skull. Children treated at Seattle Children’s have radiosurgery at the Gamma Knife Center at Harborview Medical Center.