Cranial Base Surgery (also referred to as skull base surgery) is a very small, but sophisticated specialty dedicated to the treatment of tumors that originate along the undersurface of the brain. These tumors can begin in the brain itself, along nerves and tissues that attach to the undersurface of the brain, or within the eye sockets and paranasal sinuses which are next to the brain and cranial base. The cranial base itself is best described as those areas of the skull upon which the brain rests, i.e. the eye sockets, the paranasal sinuses, the temporal bone (where the hearing organ of the ear is located), and the bone around the area where the spinal cord joins the brain. Both benign and malignant tumors affect all of these areas.

In general, the vast majority of the malignant tumors that affect the cranial base, begin in the nasal cavity or paranasal sinuses, though they can also originate in the other areas. Benign tumors, such as acoustic neuromas and meningiomas, tend to begin within the brain, or the temporal bone.

Endoscopes

Surgical endoscopes are special devices that allow the surgeon illumination and magnification to view deep and narrow areas and cavities in the body. They have been used extensively for endoscopic sinus surgery and have been modified and adapted for removal of tumors at the base of the skull. It allows surgeons to approach and remove certain tumors solely through small openings such as the nose and mouth avoiding large and invasive openings of the skull. Although the endoscopes give a direct minimally invasive access to certain specific areas of the skull base and specific types of tumors, they still require a great deal of skill and team work between the Head and Neck and Neurosurgeon.

Since our team has a great deal of experience with treating such tumors, we can appropriately select patients and tumors that may be most amenable for safe and adequate resection by the use of endoscopes or through conventional open skull base techniques. Often the surgical endoscope is used as an adjunct to supplement an open operation so that a limited exposure can suffice in a particular situation. Thus, the endoscope can be used in a whole range of ways to optimize the effectiveness of the operations. The instrumentation and techniques for performing endoscopic surgery is still evolving and has a promising future, and is a part of our armamentarium in the management of difficult tumors in these locations.