Skull Base Surgery
The skull, of bones and cartilage that forms the facial structure, encloses the cranium-an envelope to protect the brain.
On the cranial surface, one can feel the bony structures. The five bones forming the base of the cranium also form the eye socket, the roof of the nasal cavity, some sinuses, and the framework surrounding the inner ear. The skull base is a complex, densely packed region that acts as a pathway for many structures, such as the spinal cord, several blood vessels, and nerves passing through numerous openings.
What is skull base surgery use for?
Skull base surgery covers the spectrum of lesions and diseases, such as:
- Congenital cysts
- Infectious masses
- Pituitary tumors
- Meningiomas: benign tumors arising from the meninges – the cerebral protective layers
- Chordomas: slow growth bone tumors mostly located at the skull base
- Trigeminal neuralgia: characterized by extremely painful spasms in one side of the face
- Craniopharyngiomas: mass lesions located near the pituitary gland
- Craniosynostosis: premature fusion of infant skull bones, where brain development and skull shape are affected
- Cerebrospinal fluid fistulas
- Cerebral aneurysms: weak, swollen portions of brain blood vessels
- Arteriovenous malformations: improper connections of arteries and veins in the brain
These conditions need particular skull base surgical intervention to halt the progression and relief from symptoms and the danger of complications.
Types of skull base surgery
Skull base surgery can be approached in two main ways with the decision between endoscopic and open surgery dependent on the type and nature of the growth being treated:
The neurosurgeon enters from the nose using an endoscope, which is merely a long, thin, and lighted tube. For endoscopic or minimally invasive skull surgery, sometimes only an incision of a few centimeters is necessary. During surgery, radiologists can employ MRI, which can give real-time imaging guidance to assist in the removal of the growth.
Indications for Skull Base Surgery
Skull base surgery is often indicated for the following conditions:
- Tumors:
Meningiomas: Tumors arising from the meninges, often located at the skull base.
Chordomas: Rare bone tumors that can occur at the base of the skull and along the spine.
Pituitary Adenomas: Benign tumors of a pituitary gland that can be extend into the skull base.
Acoustic Neuromas (Vestibular Schwannomas): Tumors affecting the vestibulocochlear nerve, which can impact hearing and balance.
- Vascular Conditions:
Aneurysms: Bulges in the blood vessels at the skull base that can lead to hemorrhage.
Arteriovenous Malformations (AVMs): Abnormal connections between arteries and veins that can be located near the skull base.
Symptoms
Symptoms may range from the size, type, or location, as diversified as the lesion or malformation in the base of the skull can be. Some examples include:
- Pain in the face
- Headaches
- Dizziness
- Visual disturbances
- Paresthesia
- Weakness or paralysis of the face
- Hearing loss or tinnitus
- Nasal congestion or recurrent sinus infections
Treatment
Depending on the nature of growth or abnormality involved in the skull base, other treatments may be needed in addition to endoscopic and open skull base surgery:
- Chemotherapy: Drugs which are given to treat growths caused by cancer.
- Radiation therapy: Exposure to X-ray treatment to help deal with growths within the skull base that cannot be totally resected by surgery.
- Gamma knife: a Radiation therapy form in which focused X-ray beams are directed at growths in the skull base.
- Proton beam therapy: Yet another form of radiation therapy and designed for improved precision and dosing of the tumors.
- Particle therapy: As, it is one of the most advanced forms of radiotherapy employing high-energy particles with minimum adverse effects. Thus, one of the well-known forms of particle therapy is Carbon-ion radiotherapy.