Skull Base Surgery

Protecting This Critical Area

Your brain sits on your skull base, an area filled with delicate nerves important for seeing, hearing, balance and facial movement and sensation. Skull base tumors occur at this crowded area through which your brain stem and spinal cord – as well as many blood vessels and nerves – pass through. Our team of skull base neurosurgeons have many years of experience in skillfully removing these tumors, using both open and minimally invasive surgical approaches.

Our Team

Because this area is hard to reach and see, the Skull Base Surgery program brings together an integrated, collaborative team of experts from neurosurgery, otolaryngology – head and neck surgery, neuro-ophthalmology, medical oncology and radiation oncology and the CyberKnife team to provide total care … from initial diagnosis through surgical intervention and post-operative follow-up.

Neurosurgeons Dr. Yaron Moshel, Dr. Ronald Benitez and Dr. Fabio Frisoli specialize in treating acoustic neuromas,pituitary tumorscraniopharyngiomas, skull base meningiomas, metastases, trigeminal neuralgia, hemifacial spasm, encephaloceles, tegmen defects and aneurysms. They 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 to so many other anatomical areas including the face, neck, ears, nose and throat. Most experience some or all of the following symptoms:

  • Headache

  • Sinus congestion

  • Vision changes

  • Neck pain

  • Dizziness

  • Tinnitus

  • Hearing loss

  • Difficulty swallowing and/or talking

  • Difficulty swallowing and/or talking

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.

Ultimate 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.

Surgery

Skull base surgery can be done two 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 our surgeons 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. Our surgeons 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

    At the Gerald J. Glasser Brain Tumor Center we use microsurgical techniques to make traditional open surgery safer and less invasive with improved patient outcomes. During these procedures, an incision is made behind the hairline and a section of bone at the bottom of the skull is removed so that a tumor or portion of the brain can be accessed with minimal to no brain retraction, yielding better outcomes. The bone that is removed is reconstructed at the end of the operation.

    Advances in neuro-anesthesia and microsurgical techniques – typically using an operating microscope – have made this surgery safer and less invasive. A team of neurophysiologists assist during the surgery to make sure that critical brain and delicate nerve functions are monitored and preserved during surgery. In some cases, this surgery is performed with minimally invasive techniques and endoscopy, which allows for smaller incisions through an eyebrow or eyelid.

    These techniques are used for acoustic neuromas, chondrosarcomas, complex meningiomas, chordomas and other conditions centered at base of the skull such as hemifacial spasm and trigeminal neuralgia.

  • The skull base sits behind your eyes and nose … and slopes down to the back of your head.

  • Your spinal cord, multiple nerves and the major blood vessels of your brain, head and neck pass through openings in the skull base.

  • Some skull base surgery that removes a tumor or growth at the base of the skull can be performed through the nose using an endoscope, avoiding surface incisions.

  • These endoscopes can also provide access from the bottom of the skull, avoiding brain manipulation.

  • All skull base surgeries at The Gerald J. Glasser Brain Tumor Center are planned with a team of specialists including brain tumor neurosurgeons, neuro-oncologists, endoscopic sinus surgeons and radiation oncologists.

  • Together, they determine what must be removed and what can be treated with CyberKnife radiosurgery to provide the safest possible treatment plan.