Children with conditions affecting the base of skull traditionally face repeated surgeries and lengthy recoveries. It means multiple General Anaesthetics (GA), time in hospital and major impacts to their normally active lives. 

Children with conditions affecting the base of skull traditionally face repeated surgeries and lengthy recoveries. It means multiple General Anaesthetics (GA), time in hospital and major impacts to their normally active lives.

The development of the Base of Skull Services (BOSS) at Sydney Children’s Hospital, Randwick is hoping to change that.

With new, exciting models of care, it will mean children like 11-year-old David are able to receive comprehensive care while spending less time in hospital and importantly, less time under GA.

David was diagnosed with invasive fungal sinusitis earlier this year and was rushed to Sydney Children’s Hospital, Randwick for care under the new Base of Skull Service (BOSS).

The Base of Skull Service is the first integrated paediatric multidisciplinary skull base unit in the southern hemisphere. The service, which has been proudly supported by Sydney Children’s Hospitals Foundation, offers minimally invasive surgical options for children with trauma, tumours and invasive infections in and around the base of skull.

The base of skull is the most complex area in the human body. It’s home to the nerves that allow you to see, hear, smell, taste, talk, swallow, move and feel and the blood vessels that supply blood to the brain.

David’s parents, George and Sherin, first noticed something wasn’t right when yellow fluid started coming from David’s nose and his breathing became laboured. His face also appeared to be out of symmetry.

With his condition continuing to worsen over the coming days, David was rushed to his local emergency department and soon transferred to SCH for specialised treatment.

For David, the first step for confirming his diagnosis was a CT scan, a procedure he needed to have under General Anaesthetic (GA) Procedures and surgeries under GA can be challenging for most children, but even more so for David, who also lives with autism.

“As a parent, it can be challenging when David needs to have surgery because he can’t express his feelings and we don’t know how he will cope,” George said. 

“The thought that he may have to go through this several times was really overwhelming to think about.”

While the CT confirmed that David did have invasive fungal sinusitis, a rare infection of the facial sinuses, the family were met with some good news – David's follow up surgery could be performed through the EndoSuite. 

Under the new model of care, the highly trained specialist and multidisciplinary team used an endoscope and specialist equipment to remove the infected tissue through David’s nasal passage. 

The minimally invasive approach was able to be performed without the need for a full GA or any direct incisions into his skull, shaving hours off his surgery time, and days off his recovery. 

“Traditionally, sinus surgery for kids like David can involve an invasive approach and multiple GAs. However, this new model of care changes the game, reducing GA and recovery times, while improving the patient experience and never compromising on care,” Beckie Petulla, Clinical Nurse Consultant in the BOSS, said. 

“In a matter of hours, these kids are not only out of surgery, but because they haven’t had to go under GA, they are back home, at school and playing with their friends.” 

“It is really life-changing for these patients.” For David, this couldn’t be closer to the truth. “David was in and out of surgery within three hours and was able to return to school the same day,” George said. 

“He coped very well through the whole process, it was so much less stressful for him, and my wife and I could see that he didn’t experience any of the affects you would normally expect following surgery.” 

David has now fully recovered from his surgery. He is breathing normally again and is back to his energetic self.