The face and the skull, which surround the brain, are formed from bones and cartilage in the skull. On top of the skull, you may feel the cranium’s bones. The five bones that make up the skull’s bottom, or base, also create the eye socket, the roof of the nasal cavity, portions of the sinuses, and the bones surrounding the inner ear. The skull base is a busy and intricate area with numerous openings through which the spinal cord, multiple blood vessels, and nerves travel.
Skull base surgery can remove benign and malignant growths and abnormalities on the brain’s underside, the skull base, or the top few vertebrae of the spinal column. In this surgery, the surgeon introduces instruments into the skull through natural holes such as the nose or mouth or a small hole just above the brow. This operation requires a team of specialists, including ENT (ear, nose, and throat) surgeons, maxillofacial surgeons, neurosurgeons, and radiologists. Because this is such a tough place to see and access, minimally invasive endoscopic surgery may be used.
Before the development of endoscopic skull base surgery, the only option to remove growths in this part of the body was to make an opening in the skull. This type of surgery may be required in some instances.
What is skull base surgery used for?
Some of the disorders and growths that may be treated by skull base surgery include:
Cysts that form at birth
Pituitary gland cancers
Meningiomas are noncancerous tumors that arise from the meninges, which are the tissues that coat the brain and reside between the brain and the skull.
Chordomas are slow-growing bone tumors most discovered at the base of the skull.
Trigeminal neuralgia, severe pain on one side of the face
Craniopharyngiomas, pituitary gland growths
Craniosynostosis is a disorder in which an infant’s skull bones seal prematurely, creating issues with brain growth and skull shape.
Fistulas of cerebrospinal fluid
A cerebral aneurysm is a weak, typically bulging region in a brain blood artery.
Arteriovenous malformations are improper connections between arteries and veins.
Types of skull base surgery
There are two main approaches to skull base surgery. Although endoscopic surgery is the preferred procedure, open surgery is also an option, depending on the type of tumor to be removed and its location:
Minimally invasive or endoscopic skull base surgery: This surgery does not normally necessitate a significant incision. A surgeon may create a small incision inside the nose to allow a neurosurgeon to remove a growth using a thin, illuminated tube known as an endoscope. An MRI is an image of the skull base using magnets and a computer that a radiology specialist may perform while the surgical specialists are operating to ensure that all the growth has been eliminated.
Open or traditional skull base surgery: This type of surgery may necessitate facial and skull incisions. Parts of the bone may need to be removed to reach and remove the tumor. For this sort of operation, an operating room microscope is frequently employed.
A growth or anomaly in the skull base area can cause various symptoms. The following symptoms may occur depending on the size, nature, and location of the growth or abnormality:
Hearing loss or ringing in the ears
Sinus infections or nasal congestion
Your symptoms and a physical exam are used to diagnose growths or anomalies that may necessitate skull base surgery. Because this area cannot be physically examined, these tests and imaging studies are critical components of the diagnosis:
Brain imaging research: MRI (magnetic resonance imaging), MRA (magnetic resonance angiography), PET (positron emission tomography), and CT (computed tomography) scans produce images of the skull that assist your medical team in detecting a growth or abnormality.
Biopsy: A little piece of a tumor in the skull base can be removed and examined under a microscope. An endoscope inserted through the nose and sinuses can be used to perform a biopsy. Biopsies can also be performed via fine needle aspiration or excisional biopsy.
Additional tests: Balance, cranial nerves, muscle function, vision, and hearing might all be tested. Other parts and systems of the body may also be studied or scanned.
Depending on the type of growth or abnormalities of the skull base, various therapies may be required in addition to endoscopic and open skull base surgery:
Chemotherapy: These are medications used to treat cancerous tumors.
Radiation therapy: X-ray therapy may be used to manage growth in the skull base that surgery cannot eliminate.
Gamma knife: A type of radiation therapy that uses precision X-ray beams to target a tumor near the base of the skull.
Proton beam therapy: This is another type of radiation therapy that can improve tumor precision and dosage.
Particle therapy: It is the most recent type of radiation. Particle therapy includes carbon-ion radiation. It employs high-energy particles that have less adverse effects.
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