Skull base surgical approaches
The skull is made up of facial bones and the cranium, which encases the brain. The base of the skull on which the brain sits is called the skull base. It is made up of bones that form the roof of the nasal cavities, orbital (eye) cavities, inner ears and some sinuses. The skull base is a complex area having multiple openings which accommodate the spinal cord, nerves, and blood vessels. This area is approached to treat tumours or abnormalities on the under surface of the brain, base of the cranium and upper portion of the vertebral column.
There are 2 ways to approach the skull base:
- Endoscopic approach: This is a minimally invasive approach which involves accessing the tumour through the natural openings of your nose or mouth by passing an endoscope (a lighted tube). Surgical instruments are guided through the endoscope with imaging devices. This approach is preferable as it carries little risk and is associated with faster healing following surgery.
- Open approach: This is a traditional surgical approach that involves making incisions in the cranium and facial bones, and occasionally removing bone to allow access to the skull base. This approach is necessary for complicated conditions.
Some of the conditions treated with skull base surgery include:
- Craniopharyngiomas (benign tumour in the base of the brain)
- Meningiomas (tumour arising from the membranes covering the brain)
- Schwannomas (tumour of nerve cells)
- Arteriovenous malformations (abnormally connected blood vessels)
- Paranasal sinus tumours (cancer of the nasal cavity and sinuses)
- Cysts (fluid filled pockets of tissue)
- Cerebral aneurysm (weak area in a blood vessel in the brain that usually bulges)
Skull base surgery requires a multidisciplinary approach involving ENT surgeons (ear, nose and throat), neurosurgery and radiology.
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