The type of surgery used for a skull base tumor usually depends on the location of the growth, how large it is, and the degree to which it entwines blood vessels and nerves. Our surgeons are experienced in all possible surgical approaches to these tumors and can discuss the best option for you.
Endoscopic Endonasal Surgery
Some tumors, usually those located in the central part of the skull base, may be removed by surgery performed through the nostrils. This is called endoscopic endonasal surgery. It’s considered a minimally invasive procedure, because the surgeon does not have to make incisions in the skull or manipulate or move parts of the brain to get to the tumor.
Tumors such as meningiomas, pituitary tumors, craniopharyngiomas, juvenile angiofibromas, nasopharyngeal carcinomas, and esthesioneuroblastomas can usually be managed with this approach.
A team of neurosurgeons and surgical otolaryngologists—doctors who specialize in ear, nose, and throat (ENT) surgery—performs the procedure. During the surgery, which requires general anesthesia, physicians use an endoscope, a long, thin, lighted tube with a tiny camera on it, to view the inside of the nose. Surgeons place the endoscope through the nasal cavity and sinuses and then into the skull base.
The endoscope enables doctors to see the tumor and the complex skull base structures, including important nerves and blood vessels. Surgeons place small tools along the scope and into the skull base to remove the tumor.
After its removal, any remaining opening or defect in the skull base created by the tumor is repaired with multiple layers of tissue, such as your own fat tissue, synthetic tissue, or the lining of the nasal septum, which is the thin wall that separates your nostrils.
Sometimes, surgeons may use a spinal drain to divert spinal fluid into an external collection system for several days following surgery. This promotes healing of the skull base defect and prevents leakage of the fluid through the nose as you recover.
Doctors may remove a skull base tumor using an eyebrow craniotomy, in which they make an incision in the eyebrow to create a small opening in the skull. This approach provides access to tumors located in the anterior, or front portion, of the skull base. A plastic surgeon is involved in the surgery in order to achieve an excellent facial appearance after the procedure.
If a tumor can’t be easily reached using an endoscopic procedure or an eyebrow craniotomy, surgeons may need to perform a traditional craniotomy, in which they make an incision in the scalp and through the skull to remove the tumor.
This procedure may be necessary for lateral tumors, which are located farther back in the skull base. An acoustic neuroma is an example of a lateral skull base tumor. Meningiomas, chordomas, and chondrosarcomas can also occur farther back in the skull base. To remove these tumors, our physicians may make an incision behind or above the ear.
Sometimes, a tumor near the optic nerve, which governs eyesight, may need to be reached using a craniotomy. If it is not possible to remove the tumor with an endonasal endoscopic approach, then an opening is made in the front of the head.
Once a piece of the skull has been removed and the tumor is visible, surgeons remove as much of the growth as possible using microinstruments, extremely small surgical tools used in complex surgeries. This is done with the aid of a surgical microscope to provide high magnification. Afterward, they close the opening with the removed portion of skull.
A craniotomy for skull base tumors is performed using general anesthesia. Doctors wake you after the procedure and perform a neurological assessment to ensure important nerves were preserved during surgery.