Skull Base Surgery : An Evolving Interface Between Specialties

The skull base is a complex area crowded with crucial structures such as the base of the brain, spinal cord and critical blood vessels and nerves which enter and exit the brain. Many clinical conditions affecting this area (mostly tumors and life-threatening infections) are often difficult to access and treat. Open surgeries in this area often lead to significant morbidity and mortality affecting patients’ quality of life with a risk to life itself. Minimally invasive surgeries in this region have vastly improved patient-related outcomes. This type of surgery requires a combination of expertise from multiple specialities like neurosurgery, otorhinolaryngology, radiology and maxillo facial surgery. Further, the use of endoscopes, image-guided systems and advanced microscopes have helped us remove complex tumours from this region. The treatment of such complex conditions is best done at institutions offering both technological and surgical expertise.

How are skull base surgeries done?

Skull base surgeries are done either through an endoscopic approach or with a microscopic approach. The endoscopic approach avoids large incisions in the face. These types of surgeries are done by utilising the combined expertise of neurosurgeons and ENT surgeons.

Most patients will have imaging studies like an MRI or a CT scan to delineate the clinical problem. Often image guidance is used to enhance the precision of surgery. With traditional microscopic skull base surgery, advanced tumours around the ear were removed by drilling and utilising instruments like CUSA (ultrasonic aspirator), But newer technology has obviated this.

What are these complex conditions treated by People Tree Hospitals?

•  Pituitary tumours
• Infections of the skull base
• Benign and cancerous tumours of the nose and paranasal sinuses
• Chordomas
• Craniopharyngioma
• Cerebrospinal fluid leaks (CSF leak)
• Complex cerebral aneurysms
• CP angle tumours (Acoustic neuromas)
• Meningiomas

What symptoms should I be worried about?

• Facial pain
• Headache
• Facial numbness
• Ear discharge
• Hearing loss or ringing in the ear
• Visual disturbances (double vision or a restriction of the field of vision)
• Frequent sinus infections
• Pain around the eye
• Deviation of the face (facial palsy)

How is the diagnosis made?

Your doctor would take it through a thorough clinical history and do appropriate examinations which could include an endoscopy of the nose and ear.

You might then be subjected to imaging studies like CT scans and MRIs to understand the root cause of the problem.

How are these conditions treated?

As these conditions are quite complex and are often in the region between the interface of specialities (neurosurgery/ENT surgery/maxillofacial surgery), it is often treated by a group of doctors who with their joint expertise would give the best option of treatment for the best possible outcomes.

Although surgery is the main treatment option, other treatment modalities such as radiotherapy and gamma knife surgery are often added to the treatment repertoire to improve patient outcomes.