Skull Base Surgery for Tumor Removal

Even when benign (non-cancerous), tumors at the base of the skull above the cervical spine (neck) can contribute to headaches and problems with hearing, vision, facial sensations, and cognitive functioning. Smaller tumors may be treated with periodic observation if there are no significant symptoms and radiation therapy or chemotherapy.

Treatment decisions are typically based on the location and size of the tumor, overall patient health, and whether or not the tumor is benign or cancerous.

This approach to the removal of a skull base tumor is performed with a special lighted tool with an attached lens and camera, called an endoscope. During the procedure, the tumor is accessed via the nose as the endoscope is passed through the sinus cavities and into the lower brain area. There is no need to use the large retractors normally used with traditional open procedures. If the tumor is difficult to reach, an angled endoscope may be used to minimize patient risks while still accessing the tumor.

Endoscopic surgery sometimes allows tumors that would otherwise not be treatable due to their location to be safely removed. By going through the nose to access the tumor, patients won’t have to worry about noticeable scars from incisions on the scalp, back of the beck, face, or below the lips. Even where instruments are inserted in the nose, scarring is usually not visible. With less-invasive procedures, patients may also benefit from:

• Reduced surgery time
• Shorter hospitalization and post-surgery recovery time
• Not as many surgical risks
• No use of radiation during the procedure
• Less post-surgery discomfort

Both adults and children with skull base tumors have been successfully treated with endoscopic surgery. In addition to tumors, this approach to surgery may also be used to treat other issues affecting the skull base area, including rathke cleft cysts, pituitary tumors, benign tumors inside bones at the base of the skull (chondroma), and cancerous mucus-secreting glands.

Skull base surgery performed today is often performed with computer-assisted navigation, which includes better visualization capabilities. 3D views of the affected part of the brain can also allow an ENT doctor to plan and coordinate removal in a way that minimizes disruption to nearby nerves, tissues, and structures.

Another approach to the surgical removal of skull base tumors involves the use of robotic technology. Procedures of this nature allow surgeons to transfer their hand movements to a robotic arm while getting a real-time view of the affected area. The main benefit for patients is increased precision with the tumor removal process. Additional surgical approaches and techniques that may be recommended for skull base tumors include:

• Tumor removal via the eyebrow (supra-orbital craniotom)
• Surgical removal of part of the bone at the base of the skull (craniotomy)
• Tumor removal through small holes in the skull or via the mouth or nose (neuroendoscopic surgery)

With non-cancerous tumors, surgery may be the only treatment that’s necessary. With cancerous skull base tumors, radiation therapy and chemotherapy may be performed prior to surgery in an attempt to shrink the tumor and after surgery to ensure that all abnormal tissues have been treated. While most procedures performed today are minimally invasive, traditional surgical methods may be necessary for larger tumors that may not be removable with less-invasive techniques.