What is Cranial Base Surgery?

In cranial base surgery image-guided removal of bone, often in a clever and anatomically complex manner, reduces or even eliminates the need to disrupt healthy brain regions by moving them out of the way.

Skull base procedures, for example, may be designed to traverse the bone containing the ear (petrous bone), around the eye (orbit), through the nose or paranasal sinuses, low on the temple beneath the brain, or even upwardly directly from the neck region.

Fundamentally, these are minimally invasive techniques that afford the highest possible degree of tumor removal while preserving neurological function to the greatest extent possible.

When Were Cranial Base Surgery Techniques Developed?

Cranial base surgery is a relatively recent innovation. High-resolution imaging, such as CT and MRI imaging, provides the surgeon with precise anatomical details that enable rational planning of these procedures.

By precisely mapping the tumors location and its relationships to surrounding brain, nerves, and bony landmarks, it is now possible to design a rational approach for tumor removal.

What Technologies Are Used in Cranial Base Surgery?

Cranial base surgery is a technologically intensive endeavor. High-powered microscopes with fiberoptic illumination are essential, as are high powered drills (with diamond burrs) to safely navigate the cranial base bone which is crisscrossed by vital structures and a virtual forest of important nerves. 

Cranial Nerve Monitoring
Cranial nerve monitoring allows a neurophysiologist to identify structures and track the health of various nerves on a computer system. This knowledge allows the surgeon to gently microdissect the tumor from the nerve and optimize neural preservation.

Image Guidance
Cranial base surgery is highly dependent on high tech imaging of the tumor and surrounding tissues. For example, image guidance allows CT and/or MRI images of the tumor to be projected for the surgeon's use in the operating room.

Using a "magic wand" whose position is localized in 3D space, the system can identify any position inside the patient's head in reference to the location of the tumor and surrounding vital structures.

How Do Patients Do Following Skull Base Surgery?

Modern microsurgical skull base approaches have greatly improved patient results, including in tumor control, patient survival, and numerous important quality-of-life measures.

Is Surgery the Only Solution for Skull Base Tumors?

Not all skull base tumors require intervention. Some tumors grow so slowly that they pose only a minor risk of more serious problems, especially to older individuals. In such cases, the tumor may simply be monitored by periodic imaging studies.

In addition, high-technology radiation therapy is often an acceptable alternative and is at times preferable to microsurgery in selected cranial base tumors. Typically the CyberKnife is the best option for radiation of skull base tumors.