Minimally Invasive Skull Base Surgery

(415) 353-2757

Performing Minimally Invasive Skull Base Surgery

Conditions and Treatment

Benign Tumors

Angioma, angiofibroma, chondroma, craniopharyngioma, epidermoid, hemangioma, inverting papilloma, meningioma, neurofibroma, osteoma, pituitary tumors

Benign Tumors Treatment

A benign tumor is by definition non-cancerous. A biopsy of the tumor tissue (either in the office or in the operating room) and imaging (such as a CT scan and/or MRI) will determine whether your tumor is benign. Treatment of benign tumors involves surgery to remove them. Radiation or chemotherapy are never required. Frequently, these tumors can be removed through the nose using cameras (called endoscopes) and handheld instruments that cut and remove tissue. If the tumor is too large or involves areas of the sinuses and skull base that are hard to reach, an open approach may also be necessary. An open approach involves making an incision on the face to reach the tumor, with the most common incisions being under the lip, near the eye, or on the top of the head in the hairline. Depending on the location of the tumor and whether the tissue needs to be reconstructed after the tumor is removed, Neurosurgery, Oculoplastics, and/or Facial Plastic Surgery may also be involved in the surgery.

Malignant Tumors

Adenocarcinoma, adenoid cystic carcinoma, chondrosarcoma, chordoma, hemangiopericytoma, metastatic cancer, olfactory neuroblastoma, osteosarcoma, rhabdomyosarcoma, squamous cell carcinoma

Malignant Tumors Treatment

A malignant tumor means that the tumor is cancerous. This is determined by a biopsy of the tissue and imaging with CT and MRI. Sometimes a PET scan is also ordered to find out whether there is malignant tumor anywhere else in the body.
 
Treatment of malignant tumors usually involves a combination or surgery, chemotherapy, and/or radiation. The best treatment option and the sequence of treatment (for example, chemotherapy before surgery or surgery before chemotherapy) will be determined on a case-by-case basis after discussion with our Multi-Disciplinary Head and Neck Cancer Tumor Board. This specialized Tumor Board meets once a week and includes experts in pathology, radiology, chemotherapy treatment, radiation treatment, and surgery. Once the best treatment course for your individual case is determined, you will meet with the other experts who will be treating you such as Radiation Oncology or Medical Oncology.
 
If surgery is recommended, the tumor will either be removed completely through the nose using cameras (called endoscopes) and handheld instruments that cut and remove tissue, or with a combination of an endoscopic approach and open approach. An open approach involves making an incision on the face to reach the tumor, with the most common incisions being under the lip, near the eye, or on the top of the head in the hairline. Depending on the location of the tumor and whether the tissue needs to be reconstructed after the tumor is removed, Neurosurgery, Oculoplastics, and/or Facial Plastic Surgery may also be involved in the surgery.

Other

Cerebrospinal fluids leak, encephalocele, meningocele, optic nerve decompression, osteomyelitis

Treatment

Skull Base surgeons also treat non-tumor conditions such as cerebrospinal fluid leaks and infections of the sinuses and skull base. Treatment is usually surgical, such as repairing the defect in the skull base using tissue from your nose or other matrix materials. If an infection is present, antibiotics will be prescribed with the help of our Infectious Disease colleagues.

What to Expect at your Visit

  • When you come to the office, please bring any questionnaires or surveys that were sent to you. It is also important to bring all past medical and treatment records, pathology reports from previous biopsies, and images such as CT or MRI scans. If you can send this information before your appointment so that it can be scanned into your chart and reviewed by your provider, that is even better.
  • During your visit, your provider will obtain a detailed history and perform an examination which may include a nasal endoscopy, which is a camera that is used to evaluate your nose, sinuses, and skull base. Numbing spray will be used to make the camera more comfortable. It takes less than a minute to perform but can offer lots of great insight into your condition and future treatment plan. If a tissue biopsy and/or imaging (CT, MRI, or both) have already been obtained, these will be reviewed with you by your provider during the appointment. If these have not been obtained but are necessary for treatment planning, your provider will discuss this with you. A biopsy can usually be performed in the office, but sometimes requires going to the operating room if the tumor is in a spot that is difficult to access, or if the tumor has the potential to bleed a lot. Any imaging that is ordered will be scheduled to occur in the days or weeks after your appointment.
  • Once all the important information about your condition has been obtained, a diagnosis will be given and treatment planning will start. If it is a benign (non-cancerous) tumor, your provider will discuss the option of surgery and go over the steps of this with you. If it is a malignant (cancerous) tumor, your case will be presented at the weekly Multi-Disciplinary Head and Neck Cancer Tumor Board with all the experts in pathology, radiology, surgery, chemotherapy, and radiation therapy present. Based on this discussion, a treatment plan tailored to your tumor (surgery, chemotherapy, and/or radiation) will be recommended.

Patient Education