Skull Base Surgery
Skull Base Surgery
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Tumors that grow in the base of the skull—behind the eyes and nose—are some of the most challenging to treat. This area is very close to critical nerves and blood vessels in the brain, head, neck, and spinal cord. Even benign (non-cancerous) tumors of the skull base can cause vision or hearing loss and impact growth, hormone production, fertility, or balance.
Fortunately, new minimally invasive surgical techniques have been developed in the last decade that make the removal of many skull base tumors possible without large incisions. Using tiny endoscopic instruments, surgeons can now remove some tumors through the nostrils or through tiny incisions in the eyebrow or the back of the ear.
At Columbia Otolaryngology, we are dedicated to the safest, most comprehensive treatment and removal of skull base tumors. Our highly skilled surgeons have extensive experience in both open and minimally invasive endoscopic surgery. A multi-disciplinary approach to these conditions ensures that a whole team of neurotologists, rhinologists, radiation oncologists, neurosurgeons, medical oncologists, pathologists, and therapists will work towards the best possible outcome for your surgery.
Skull Base Tumors We Treat
Our specialists are skilled in treating the full range of skull base tumors, including:
- Pituitary tumors
- Acoustic neuromas (or vestibular schwannoma)
- Nerve sheath tumors (schwannomas and neurofibromas)
- Paragangliomas (glomus tumors)
- Orbital tumors (hemangiomas, schwannomas, meningiomas)
- Epidermoids and dermoid tumors
- Juvenile angiofibromas
- Nasopharyngial carcinomas
- Adenoid cystic carcinomas
- Temporal bone cancers
Minimally Invasive Skull Base Surgery
Until recently, many skull base tumors were considered inoperable because accessing the tumor during surgery was more risky than the tumor itself. The field of skull base surgery was created to develop specialized pathways to reach these tumors without damaging critical structures along the way.
The skull base includes structures that sit within the bone behind the eyes, behind the nose, and deep to the ears. This complex anatomy involves dense arrangements of blood vessels, nerves, the brain, and sensory structures (such as for smell, vision, balance, and hearing).
The early years of skull base operations involved making big incisions, removing large bone segments, and sometimes retracting the brain in order to see and remove tumors. Recovery from the approach to the tumor was sometimes worse than from the tumor removal itself.
Today, many skull base tumors are taken out using less invasive approaches. For example, tumors of the pituitary gland and adjacent regions may be removed entirely through the nose without any skin incisions. These advances are due to improvements in surgical instrumentation, imaging, and training. Endoscopes with high-resolution cameras allow detailed views deep within the head, eliminating the need for creating larger openings in the body.
Our skull base surgeons employ the most advanced technologies to reach and remove complex skull base tumors. There is also active effort to expand minimally invasive techniques to include more and more types of skull base tumors.
Specialized Skull Base Tumor Board
The Department of Otolaryngology—Head and Neck Surgery has spearheaded a larger and more formalized multidisciplinary Skull Base Tumor Board. The board meets monthly at Columbia University Irving Medical Center and brings together skull base tumor experts to discuss optimal treatments for individual patients. Complex tumors are discussed, including meningiomas, acoustic neuromas, pituitary tumors, and schwannomas. The board includes subspecialized otolaryngologists, skull base and cerebrovascular neurosurgeons, radiation oncologists, neuroradiologists, and neuropathologists. With this pooled experience, the tumor board makes patient-centered decisions that result in more individualized and advanced care.