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When is Skull Base Surgery Needed?

Disorders that may require skull base surgery include:

  • brain tumors, including pituitary 
  • congenital craniofacial deformities
  • microvascular nerve compression syndromes (trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia ) 
  • cranial extensions of head and neck cancers
  • acoustic neuromas
  • meningiomas
  • clival tumors (chordoma, chondrosarcoma)
  • cerebral aneurysm
  • arteriovenous malformations (AVM)
  • trauma to the skull base

Skull base surgery is most frequently needed to remove tumors that sit underneath the brain and are difficult to reach. Skull base tumors may not show symptoms until they become large enough to impair neurologic function. In the past, surgery placed significant stress on the brain because the brain was often lifted out of the way to remove the tumor beneath it.

Skull surgeries are now designed to reduce risk to the brain by removing bone at the base of the skull so the surgical site can be approached from underneath rather than by moving the brain. This can be done several ways, including traversing the bone containing the ear, low on the temple beneath the brain, around the eye, through the nose or from the neck. Some of the procedures allow minimally invasive endoscopic approaches, but all are designed to give the surgeon the maximum to ability treat the condition, while providing the least amount of risk to the brain and minimizing neurologic deficits.