Skull Base Surgery
Skull Base
The skull base (or cranial base) is the part of the skull (cranium) that supports the brain and separates the brain from the rest of the head. Blood vessels to the brain and nerves from the brain (cranial nerves) run through holes in the skull base. Below the skull base are the nasal passages, sinus cavities, facial bones, and muscles associated with chewing.
Skull Base Surgeons
A Skull Base Surgery team consists of collaboration between two surgical specialties — otolaryngologists-head and neck surgeons and neurosurgeons working together as skull base surgeons.
Skull Base Tumours
Skull base tumours are not brain tumours but those that grow in a specific location: the skull base – meaning the bones of the skull that form the bottom of the head and the bony ridge behind the nose and eyes. Skull base tumours may be of several different types.
Modern Skull Base Surgery
Over the last decade, new surgical techniques have been pioneered that allow the majority of skull base surgeries to be performed through the nasal passages using an endoscope: The Endoscopic Endonasal Approach (EEA). Skull base surgery may be done to remove both noncancerous and cancerous growths.
Endoscopic Skull Base Surgery
The Endoscopic Endonasal Approach (EEA) is a minimally invasive surgical approach to the skull base wherein a multidisciplinary surgical team removes skull base tumours and lesions through the nose. EEA is performed using a narrow telescope called an endoscope.
An endoscope is an instrument that provides visualization within a narrow passage or cavity like the nose and paranasal sinuses. All three stages of surgery (approach, resection or tumour removal, and reconstruction) are performed through the nasal passages without the need for scalp or facial incisions. While these types of surgeries are described as minimally invasive, they often also allow the surgeons to perform more complete surgeries.
The concept of modern skull base surgery comes from doing a less invasive procedure that can result in a more effective outcome for the patient. While EEA can be the solution for most tumours at the skull base, it is not the answer for all of them. The expert team makes a joint discussion and then decides which is the best approach for that patient. At times open craniofacial resection remains the best approach for extensive skull base tumour not amenable to endoscopic approach.