Surgery for Skull Base Tumors
Doctors at NYU Langone are highly experienced in treating all types of skull base tumors. Treatment may take place at one of two specialized centers: the Anterior Skull Base Surgery Program and the Lateral Skull Base Surgery Program. Depending on the type and location of the tumor, doctors can perform surgery using anterior, meaning approached from the front, or lateral—approached from the side—techniques.
When reconstructive surgery is necessary, plastic surgeons—including those who specialize in preserving facial appearance—become part of your care team. NYU Langone laryngologists, who specialize in preserving vocal cord function, may also be involved in your treatment. The team works together to remove the tumor and restore normal function as thoroughly as possible.
Many skull base tumors can be removed with minimally invasive approaches, which do not require making incisions through the skull. Sometimes, due to a tumor’s location or size, it may need to be removed through open surgery, called craniotomy.
Our surgeons are among the most experienced in the world at both open and minimally invasive skull base surgical techniques. They develop the most effective surgical plan for you, depending on the location of the tumor.
If a tumor can’t be completely removed, additional treatments—such as radiation therapy or medications—may be needed. Our doctors engage you and your family members in the planning and decision process.
Image Guidance During Surgery
Many times, surgery is guided by computer software that incorporates MRI and CT scans of the tumor. This helps surgeons pinpoint the location of the tumor and to avoid critical structures. It is also used to determine the best possible surgical route to the tumor, which may be located deep within the skull base.
A team of clinical neurophysiologists—doctors who specialize in how the nervous system works—monitor the brain and spinal cord during surgery. This approach provides real-time feedback on certain nerves, the brain, and the brain stem during the surgery. The information is immediately relayed to the surgeon, providing an added layer of safety in helping to minimize injury to these structures.
Types of Surgery
The type of surgery used for a skull base tumor usually depends on the location of the growth, how large it is, and the degree to which it entwines blood vessels and nerves. Our surgeons are experienced in all possible surgical approaches to these tumors and can discuss the best option for you.
Endoscopic Endonasal Surgery
Some tumors, usually those located in the central part of the skull base, may be removed by surgery performed through the nostrils. This is called endoscopic endonasal surgery. It’s considered a minimally invasive procedure, because the surgeon does not have to make incisions in the skull or manipulate or move parts of the brain to get to the tumor.
Tumors such as meningiomas, pituitary tumors, craniopharyngiomas, juvenile angiofibromas, nasopharyngeal carcinomas, and esthesioneuroblastomas can usually be managed with this approach.
A team of neurosurgeons and surgical otolaryngologists—doctors who specialize in ear, nose, and throat (ENT) surgery—performs the procedure. During the surgery, which requires general anesthesia, doctors use an endoscope, a long, thin, lighted tube with a tiny camera on it, to view the inside of the nose. Surgeons place the endoscope through the nasal cavity and sinuses and then into the skull base.
The endoscope enables doctors to see the tumor and the complex skull base structures, including important nerves and blood vessels. Surgeons place small tools alongside the scope and into the skull base to remove the tumor.
After its removal, any remaining opening or defect in the skull base created by the tumor is repaired with multiple layers of tissue, such as your own fat tissue, synthetic tissue, or the lining of the nasal septum, which is the thin wall that separates your nostrils.
Sometimes, surgeons may use a spinal drain to divert spinal fluid into an external collection system for several days following surgery. This promotes healing of the skull base defect and prevents leakage of the fluid through the nose as you recover.
Doctors may remove a skull base tumor using an eyebrow craniotomy, in which they make an incision in the eyebrow to create a small opening in the skull. This approach provides access to tumors located in the anterior, or front portion, of the skull base. A plastic surgeon is involved in the surgery to help preserve facial appearance after the procedure.
If a tumor can’t be easily reached using an endoscopic procedure or an eyebrow craniotomy, surgeons may need to perform a traditional craniotomy, in which they make an incision in the scalp and through the skull to remove the tumor.
This procedure may be necessary for lateral tumors, which are located farther back in the skull base. An acoustic neuroma is an example of a lateral skull base tumor. Meningiomas, chordomas, and chondrosarcomas can also occur farther back in the skull base. To remove these tumors, our doctors may make an incision behind or above the ear.
Sometimes, a tumor near the optic nerve, which governs eyesight, may need to be reached using a craniotomy. If it is not possible to remove the tumor with an endonasal endoscopic approach, then an opening is made in the front of the head.
Once a piece of the skull has been removed and the tumor is visible, surgeons remove as much of the growth as possible using microinstruments, extremely small surgical tools used in complex surgeries. This is done with the aid of a surgical microscope to provide high magnification. Afterward, they close the opening with the removed portion of skull.
A craniotomy for skull base tumors is performed using general anesthesia. Doctors wake you after the procedure and perform a neurological assessment to ensure important nerves were preserved during surgery.
Recovery from Surgery
The hospital stay after surgery for a skull base tumor can range from a few days to a week. Minimally invasive procedures, such as endoscopic endonasal surgery, may allow you to recover more quickly, although everyone has a different healing time. Some people benefit from a period of inpatient rehabilitation at NYU Langone’s Rusk Rehabilitation to improve their strength and balance.
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