The Base of the Skull comprises of the intracranial compartment below the brain parenchyma, the bony interface that supports the intracranial structures and extracranial structures that are a part of the face and the neck. This is one of the most complex anatomical areas of the body because it not only involves the brain, brainstem and the spine but also involves the area of passage of important neurovascular communications between these structures and the rest of the body. The bony interface between the intracranial and extracranial structures provides many conduits for the passage of the cranial nerves and vital arterial and venous systems. Pathology in this area can be challenging to treat due to the close association with the disease to the abovementioned vital structures.
With the advent of skull base surgery and advancement in surgical technique, it has become possible to access deep areas in the base of the skull with minimal retraction and disruption of neurological structures. The concept is to remove bone, displace extra cranial soft tissue to gain access, and control the vascular supply to lesions early; to make deep seated skull base lesions behave like more readily accessible convexity lesions, thereby applying less pressure on the brain itself.
WHAT ARE THE DISEASES OF THE SKULL BASE?
Diseases of the Skull Base include
- Vestibular Schwannomas (Acoustic Neuromas)
- Trigeminal Neuromas and Neuralgias
- Facial Nerve Neuromas
- Posterior Cranial Fossa & Sphenopetroclival Meningiomas
- Lower Cranial Nerve Schwannomas
- Chordomas
- Chondrosarcomas
- Petrous Bone Cholesteatomas
- Petrous Apex Cholesterol Granulomas
- Giant Cell tumors
- Temporal Bone Malignancies
- Skull Base Paragangliomas (Tympanojugular Paragangliomas)
- Skull Base Rhabdomyosarcomas
- Pituitary Adenomas
- Sino-nasal malignancies
- Craniopharyngiomas
- Juvenile Nasopharyngeal Angiofibromas
- Inverted Papillomas
- Sino-nasal mucoceles
- Carotid Body Tumors
- Parotid tumors
- Oropharyngeal tumors
- Other Skull Base tumors
WHAT ARE THE TREATMENT OPTIONS?
Treatment options for tumors of the Skull Base include three main modalities. Wait-and-Scan, Surgery and Radiotherapy. A Wait-and-Scan approach is usually employed for slow growing benign tumors that are asymptomatic or minimally symptomatic. Surgery and Radiotherapy are curative options. Surgery is the mainstay of treatment in most large malignant and benign tumors of the Skull Base. Surgery may achieve total or near-total disease clearance depending on the involvement of vital structures. Radiotherapy offers a non-invasive modality of treatment in certain smaller tumors, especially malignant ones.
The experts in the multidisciplinary team will give due consideration to all the characteristics of the disease before offering a comprehensive solution advocating any of the above modalities or a combination of them. All treatment options that will be advised will be based on the latest scientific evidence available in the medical literature.
