Skull Base Surgery

What Is the Skull Base?

The skull base is the lower area of the skull that separates the brain from the nasopharynx, the facial skull, and the neck. It is divided into three levels. The anterior cranial fossa contains the brain's frontal lobe, the middle cranial fossa contains the temporal lobe and most of the exit sites for nerves and vessels, and the posterior cranial fossa contains the cerebellum. The twelve cranial nerves, the brain's vessels, and the spinal cord pass through the skull base. If a space-occupying process, inflammation, or injury occurs in the skull base area, it can lead to various symptoms. This can be explained quite simply. The cranial nerves passing through the skull base fulfill very different functions and show other failure symptoms when damaged.

Due to the large number of sensitive structures that pass through the skull base, skull base surgery is one of the most challenging areas in surgery.

Which Diseases Can Occur at the Skull Base?

Various space-occupying tumors can develop at the skull base, which can be of benign and malignant origin. The most common tumors include acoustic neuroma, a benign tumor that originates from the Schwann cells of the vestibular nerve; meningiomas, which are tumors of the meninges; and pituitary adenomas, which originate from the pituitary gland. These space-occupying processes can exert pressure on surrounding brain structures, nerves, and vessels due to increased size or likewise show infiltrative growth. Therefore, different symptoms occur depending on which structure is affected. Possible symptoms include visual disturbances, taste and smell disturbances, double vision, facial pain, paralysis, dizziness, and unsteady gait. Similarly, there may be pressure on the brainstem, or cerebrospinal fluid drainage may be disrupted.

However, the skull base can also be affected independently of space-occupying cell growths. For example, if an accident results in an injury to the bony structures of the skull base, this can cause cerebrospinal fluid to leak.

This can develop into a cerebrospinal fluid fistula, connecting the cerebrospinal fluid system with the surrounding spaces. Furthermore, inflammation and vascular disease can also affect the skull base and are among the possible conditions requiring treatment in this area.

What Does Skull Base Surgery Provide?

The surgical procedure can be planned after diagnosis in a detailed clinical examination and supplementary imaging procedures such as magnetic resonance imaging and computed tomography. This is done by determining the exact size and location of the tumor or pathological changes, allowing the surgeons to picture the intervention better. However, tumors at the base of the skull are often challenging to reach and require many years of expertise and exceptional sensitivity during the procedure. Therefore, the surgery is usually microsurgical, endoscopic, or combined. Navigation systems are used to support the procedure with computer-assisted guidance. In addition, the principle of neuromonitoring is applied to visualize the nerve conduction and protect the nerve from injury caused by surgery. Access is through the nose, mouth, or by opening the skull base. If it is not possible to remove the entire disease-related process due to infiltration of surrounding structures, radiation therapy may be considered an additional treatment.

What Are the Risks of Skull Base Surgery?

Surgery at the base of the skull involves some risks due to its proximity to sensitive structures. These are, among others, possible damage to the cranial nerves and injury to the spinal cord from the surgery. If an infiltrating process is present, surgery can improve symptoms, but it can also worsen them if a nerve is more affected during surgery than before. In addition, there are typical risks, such as bleeding and post-operative bleeding, inflammation, and wound healing problems, which can occur with any surgery.

Which Doctors and Clinics Are Specialized in Skull Base Surgery?

Because of the multiple structures and the connection of the skull base to the nasopharynx and face, skull base surgery is an interdisciplinary specialty. Neurosurgeons operate on the skull base, but otolaryngologists also carry out procedures performed through the nose. Often, surgery is performed in collaboration with neurosurgeons, otolaryngologists, oral and maxillofacial surgeons, and radiation oncology medical specialists. Before the surgery is carried out, the medical professionals meet for an interdisciplinary conference where the intervention options and potential difficulties can be discussed, and a therapy concept is designed.

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in skull base surgery and are awaiting your inquiry or request for treatment.

Sources:

• eref.thieme.de/ebooks/747210
• neurochirurgie.uk-koeln.de/erkrankungen-therapien/schaedelbasischirurgie/
• www.ukm.de/index.php
• www.uniklinik-freiburg.de/neurochirurgie/schwerpunkte/schaedelbasischirurgie.html
• flexikon.doccheck.com/de/Liquorfistel
• www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/hirntumor/meningeome.html