Skull Base Surgery


Your brain sits on your skull base, the crowded area that your spinal cord – as well as many blood vessels and nerves – pass through. If there are benign or malignance growths or abnormalities in this underside part of your brain or the top few vertebrae of your spinal column, you may need surgery.

Because this area is hard to reach and see, our Skull Base Surgery program brings together an integrated, collaborative team of experts from neurosurgery, otolaryngology – head and neck surgery, neuro-ophthalmology, and radiation oncology to develop individualized treatment plans. We specialize in treating acoustic neuromas, pituitary tumors, craniopharyngiomas, skull base meningiomas, metastases, trigeminal neuralgia, hemifacial spasm, encephaloceles, tegmen defects and aneurysms. And we employ the most advanced open and minimally invasive techniques – including microsurgery, radiosurgery and cranial base approaches – to provide the most effective, safe care … and the best outcomes.

Diagnosing Skull Base Conditions

Conditions affecting the floor of the cranial cavity can be difficult to diagnosis given the proximity of so many other anatomical areas, including the face, neck, ears, nose and throat. Most patients come to us presenting some or all of the following symptoms:

  • Headache
  • Sinus congestion
  • Vision changes
  • Neck pain
  • Dizziness
  • Tinnitus
  • Hearing loss
  • Difficulty swallowing and/or talking
  • Endocrine dysfunction

Depending on the area affected, these symptoms may be linked to nerve compression, fluid buildup or interrupted blood flow due to the presence of a tumor or other cranial condition. The type of symptom often tells us which area, or compartment, of the brain is affected.

Final diagnosis involves analysis of patient history, and data gathered using MRIs, CTs, PET scans, blood work, MRA, angiography and/or endoscopy of the sinuses as well as evaluations designed to gauge balance, vision and hearing.


Skull base surgery can be done in two main ways. Although the preferred method is endoscopic, open surgery is also an option, depending on the type of growth that needs to be removed and its location:

  • Endoscopic or Minimally Invasive Skull Base Surgery

    Endoscopic technology – which allows your surgeon to access lesions in your brain and skull base through the natural openings of your face without making incisions – is rapidly evolving. Frequently, this is done through the nose using an endoscope, a flexible tube with an attached camera. Your surgeon can view around corners without manipulating critical structures – and forceps and scissors can be installed on the endoscope to operate or remove tissue. By approaching tumors from below the skull and through the nose, there is less pain. There are no incisions or brain retraction, leading to better neurological outcomes after surgery.

    This technique is often an option for pituitary tumors, craniopharyngiomas, meningiomas, encephaloceles, chordomas, rheumatoid disease of the cervical spine and other cranial base tumors.

    Our surgeons work as a team with experts in otolaryngology – head and neck surgery, neuro-radiology, radiation oncology, neuro-endocrinology, endovascular neurosurgery, and neuro-ophthalmology to provide total care … from initial diagnosis through surgical intervention and post-operative follow-up.

  • Traditional or Open Skull Base Surgery

    This type of surgery generally requires an incision behind the hairline and opening of the skull. Advances in neuro-anesthesia and microsurgical techniques (typically an operating microscope is used) have made this surgery safer and less invasive. In this type of surgery, bone surrounding the skull base is removed so that the surgeon can access the skull base with minimal to no brain retraction at all which leads to better outcomes. The bone that is removed is reconstructed at the end of the operation. In some cases this surgery is performed with minimally invasive techniques and combined with an endoscope, which allows for smaller incisions and even surgery through an eye-brow or eyelid incision.