2025 Annual Report

PATIENT CARE PATIENT CARE, QUALITY & SAFETY

AN ENDOSCOPIC APPROACH FOR SKULL BASE CONDITIONS

A growing number of children with complex skull base conditions can now be treated with minimally invasive surgery at Children’s of Alabama thanks to a collaboration between pediatric neurosurgeon James M. Johnston, M.D. and otolaryngologist Jessica Grayson, M.D. Together, they lead an integrated pediatric skull base surgery program that offers endoscopic procedures for conditions such as skull base tumors, traumatic injuries, complex pituitary lesions, and congenital abnormalities such as encephaloceles—in which brain tissue protrudes through an opening in the skull. “Endoscopic approaches have been part of pediatric neurosurgery here for years for things like hydrocephalus or intraventricular tumors,” said Johnston, director and professor of the Division of Pediatric Neurosurgery at Children’s and the University of Alabama at Birmingham (UAB). “What’s new and exciting is how we’ve expanded endonasal skull base surgery through this collaboration.” The procedure involves threading a tiny camera and instruments through the patient’s nasal passages to reach the brain. “That means smaller incisions, less blood loss and a much shorter recovery time,” said Grayson—one of the few clinicians in the country who is fellowship trained in rhinology and skull base surgery for both adults and children, with extensive expertise in endoscopic endonasal surgery. After tumor removal, Grayson works to patch any small holes created between the brain and the nose. This is one of the most critical aspects after the removal— if the small holes aren’t properly sealed, cerebral spinal fluid could leak out into the

“Endoscopic approaches have been part of pediatric neurosurgery here for years [...] what’s

exciting is how we’ve expanded

endonasal skull base surgery through this collaboration.”

JAMES M. JOHNSTON, M.D.

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CHILDREN’S OF ALABAMA | UAB MEDICINE