Skull Base Neurosurgery

The skull base is the bottom portion of the skull. This area is extremely delicate because every nerve that connects the brain with the rest of the body must move through this area. In addition, this is where the large blood vessels that supply oxygen to the brain exist. The most common form of abnormality that would require surgery in this area is a tumor, often benign. This is also a common location for an abnormality of a blood vessel or aneurysm. Skull base neurosurgery usually is performed by removing the bone at the base of the skull to minimize the manipulation of the skull.

Risk Factors

Doctors are unsure of what specifically causes skull-based tumors. In rare cases, they have been linked to radiation exposure and also genetics. The cause of aneurysms at the base of the skull also is largely unknown; however, a small percentage is genetically transmitted. Cigarette smoking and high blood pressure can cause aneurysms to grow and bleed.

Symptoms

Skull-based tumors usually do not show symptoms until they grow to a size where they exert pressure on the nerves and brain. These tumors can cause a variety of neurological symptoms such as headaches, vomiting, drowsiness, first-time seizures, double vision, facial pain or twitching, hearing loss, loss of balance or dizziness, hoarseness, speech difficulties, change in personality and tongue weakness. Aneurysms usually do not cause symptoms until they bleed.

Detection and Diagnosis

Before skull base surgery is performed, it is necessary to perform a variety of tests to diagnose the condition. Usually, it is necessary to perform an MRI, CT, MRA and a standard angiography.

Treatment Options

Before the skull base surgery, medications are administered to reduce swelling and inflammation. Alternatives to surgery include chemotherapy, embolization and radiation. During the surgery, it is necessary to remove bone at the base of the skull. Bone removal allows surgeons to expose the tumor or aneurysm without manipulating the brain. The usual paths are through the ear bone, at the temple beneath the brain, above the eye, through the nose or from the neck.

In addition, a craniotomy usually is performed. Surgeons take care to minimize the size of the bone opening so that recovery from surgery is expedited.

After the surgery, it is necessary to reconstruct the layers covering the brain so that no leakage of cerebrospinal fluid occurs. It may also be necessary to transport tissue from other areas of the body to help with this reconstruction.

Refinements in skull base surgery techniques now allow neurosurgeons to safely treat what were previously felt to be inoperable brain tumors. Selecting a center with experienced and subspecialized surgeons helps to provide successful outcomes.

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To contact GW Neurosurgery call 202-741-2750.

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