Isabel “Isa” Tirado, a lively 10-year-old, was diagnosed at age 7 with craniopharyngioma, a rare brain tumor that damaged her vision. A specialized team at 鶹ѧƷ performed minimally invasive surgery to remove most of the tumor while preserving vital hormone function. Now in a clinical trial and receiving ongoing care, Isa continues to thrive and enjoy the activities she loves.
In a lot of ways, Isabel Tirado is just like any other 10-year-old.
She loves reading and playing the piano. She enjoys taking art classes and singing in the school choir. She’s an avid skier and loves to play with her little sister. She joined her school’s track and field team this year.
However, Isabel—or “Isa,” as her family calls her—is extraordinary.
When Isabel was 7 years old, she was diagnosed with craniopharyngioma, a rare kind of brain tumor near the pituitary gland at the base of the brain. Although benign, these tumors wreak havoc on the entire endocrine system, making craniopharyngiomas a lifelong condition.
For Isabel, the first symptom was changes in her vision.
When she was just 6 years old, her mom, Jayne, noticed some changes in Isabel’s behavior.
“She started being more timid about things and being clingy,” Jayne said. “Neither of these things are a part of her personality at all.”
Isabel also began holding books and other things close to her face.
“We went to the eye doctor, and they gave her eyeglasses to correct her vision,” Jayne said. “He initially thought that, since she was so young, things would resolve as she got older.”
Even with eyeglasses, Isabel failed the vision test during the next school year. At this point, Isabel’s ophthalmologist referred her to a pediatric ophthalmologist at 鶹ѧƷ, who initially thought a genetic condition was causing her vision loss. Days after this initial meeting, Isabel had an MRI, which showed her tumor.
Once the imaging discovered the tumor, Isabel was referred to pediatric neurosurgeon Samuel Cheshier, MD, PhD, who gave the official diagnosis of craniopharyngioma.
Isabel’s craniopharyngioma had crushed her optic nerve, leaving her with just 50 percent of her vision in one eye and 5 percent in the other. It was essential to get the tumor removed as soon as possible—not just to preserve Isabel’s remaining sight but for her overall health.
Anterior skull base tumors like Isabel’s are found in the front of the skull base near where the eye sockets and sinuses are located. For some patients, surgeons perform a craniotomy, removing a portion of the skull to access the tumor for removal.
Luckily, 鶹ѧƷ has a large, minimally invasive skull base team that is recognized by the North American Skull Base Society.
This multidisciplinary team consists of neurosurgeons, neuroradiologists, head and neck pathologists, cancer surgeons, and endoscopic neurorhinology skull base surgeons who are specialized otolaryngologists (ENT) to ensure the best treatment outcomes for patients like Isabel.
Because of the location of Isabel’s tumor, an expert surgical team was organized. Led by Dr. Cheshier, the team included Jeremiah Alt, MD, PhD, a neurorhinologist who specializes in endoscopic skull base tumor surgery.
Alt and his team’s expertise led Isabel and her family to choose a much less invasive option called endoscopic transsphenoidal surgery.
In transsphenoidal surgery, surgeons access the tumor through the nose and sphenoid sinus. This procedure can be performed using an endoscope, a microscope, or both, depending on the patient’s condition.
“Dr. Alt was the mastermind behind the transsphenoidal approach,” Jayne said. “Without him, you are looking at the traditional brain surgery—a craniotomy.”
While Alt and his colleagues frequently operate on craniopharyngioma patients of all ages, pediatric cases like Isabel’s are very rare.
“When we have a pediatric patient like Isabel, we bring the entire team onto the case,” Alt said.
Isabel’s surgery was a success; although Dr. Cheshier, Dr. Alt, and the rest of the surgical team safely removed a portion of the tumor, a small piece was left on the pituitary gland to avoid the increased risk of completely damaging her ability to regulate her hormones.
Because of the location of the tumor, Isabel will always need to take medication to help manage her adrenal insufficiency and hypothyroidism. But her symptoms have been as mild as they have ever been since surgery.
Unfortunately, nothing could be done about Isabel’s vision loss.
“The vision loss wasn’t from the surgery,” Jayne said. “The tumor crushed her optic nerve long before she even had surgery. Luckily, she should be able to preserve the vision she still has.”
Isabel doesn’t let anything slow her down.
“We do everything we did before she lost her vision until she says she doesn’t want to do it,” Jayne said. “We just modify and make everything safe for her to continue doing.”
The Tirado family moved to Utah eight years ago when Jayne’s husband started the University of Utah’s Executive MBA program. After the program finished, they just never left.
“Now we could never leave Utah,” Jayne said. “We can’t recreate the care team that we have.”>
Isabel has an MRI every three months at 鶹ѧƷ to check on the growth of the tumors in her brain. “These ongoing visits and checkups help us know if the tumor is growing,” Jayne said.
Earlier this year, Isabel joined a clinical trial at 鶹ѧƷ to see if a new medication would help shrink her tumor.
So far, the medication seems to be helping slow the growth.
Luckily, no matter what happens, Isabel has a world-class team of experts taking care of her.
“We are grateful we have the care team we have and that we get to work with Dr. Alt,” Jayne said. “He’s very caring, very practical, and he always makes sure Isa understands what’s going on.”
For Alt, caring for patients like Isabel is a special kind of opportunity.
“I just love what I do,” Alt said. “I love taking care of these kinds of complex problems, and I especially enjoy taking care of the pediatric population. There’s a special place in my heart for it.”
U of U Health's Skull Base Tumor Second Opinion Program
Facing a medical diagnosis can be overwhelming. Our world class experts offer second opinions on skull base tumors.
