Skull base surgery is a procedure done to access and remove tumors or other lesions at the bottom of the skull, upon which the brain rests. To avoid injuring the brain, skull base lesions are reached from the side or underneath the skull. Skull base surgery is often used to treat tumors, but it is also used for arteriovenous malformations (AVMs), a condition in which blood vessels become tangled, and congenital anomalies, or conditions present from birth.
Depending on the region of the skull base in which the lesion is located, the types of surgery that can be performed include:
- Anterior skull base surgery, which treats lesions in the area above the eyes and behind the nose. Tumors of the anterior skull base include paranasal sinus tumors, pituitary tumors, and meningiomas, which develop in the tissue between the skull and the brain.
- Middle skull base surgery, which treats lesions in the region behind the eyes around the pituitary gland. Tumors of the middle skull base include meningiomas, pituitary tumors, and cholesteatomas, which are skin growths that occur in the ear.
- Posterior skull base surgery, which treats lesions around the brainstem and cerebellum. This is the region near where the brain meets the spinal cord. Tumors of the posterior skull base include meningiomas and acoustic neuromas, which develop on a nerve connecting the ear to the brain.
Surgery can be performed with a minimally invasive or open approach. Open skull base surgery requires a craniotomy, which is a surgical drilling of the skull done to expose and access the lesions. The hole or holes in the skull are replaced following surgery. Minimally invasive approaches include endoscopic skull base surgery, which uses a thin tube (endoscope) inserted through the nose, mouth, or an opening made above the eyebrow. Open surgery is usually reserved for larger lesions that cannot be removed endoscopically.
Following your operation, you may require monitoring or testing. Depending on the type of procedure, you will need to stay in the hospital for 1-2 days or up to a week, and it can take anywhere from a few days or weeks (for minimally invasive approaches) to months (for open approaches) before you can return to your normal activity level.