If you or a loved one has been diagnosed with a condition requiring evaluation by our health care providers in neurosciences, you undoubtedly have many questions. The members of our dedicated team are more than happy to help you find the answers. Please take the time to research your diagnosis and the many treatment options available so you can make an informed decision that works best for you.
Please find below a list of common questions regarding the types of surgery our skull base team performs.
What is skull base surgery?
“Skull base surgery” or “cranial base surgery” refers to operations performed on or around the bony structures that surround the deepest part of the brain and brainstem. These surgeries tend to be very complex because of the number of blood vessels and nerves that course through small openings in the bones.
The guiding principle of skull base surgery is to choose the right approach that minimizes the need to manipulate sensitive structures while still obtaining the goals of surgery.
What types of conditions require a skull base surgeon?
Many disorders of the blood vessels or nerves in and around the skull base require surgical treatment. In addition, certain brain tumors or vascular malformations may benefit from a skull base approach to avoid unnecessary manipulation of the brain. View a list of conditions treated by our skull base team.
Who does skull base surgery?
The variety of conditions treated by skull base surgeons lends itself to a team approach. Otolaryngologists and neuro-otologists work closely with members of the neurosurgery team to provide a safe, effective surgical experience.
Neurosurgeons that specialize in skull base surgery often have one or two years of fellowship training that focuses specifically on these surgeries.
What is "conventional" or "traditional" skull base surgery?
“Traditional” or “conventional” skull base surgery refers to techniques that involve creation of pathways in the skull base sufficient for “microscopic” treatment of lesions. An operating microscope magnifies the surgical field to allow the surgeon to work through a small opening. The amount of bony removal can be tailored according to the size of the lesion that needs to be treated.
These surgeries often require large incisions through the soft tissue of the scalp (e.g. the skin and muscle) to expose the bony structures of the skull base. These incisions are generally hidden behind the hairline to make them more cosmetically appealing.
What is "minimally invasive" skull base surgery?
Although there is no universal definition for “minimally invasive” skull base surgery, this principle refers to the use of natural anatomic corridors, such as the structures around the eyes and nose, to reach lesions located deeper in the skull base or brain tissue. The advances in imaging and visualization technology (microscopes and endoscopes) have led to an increasing popularity in surgical approaches that decrease the amount of bone removal and soft tissue disruption without sacrificing the efficacy of the surgery.
Is this surgery safe?
This surgery is safe and effective for the right indications. The expertise of the surgeon in selecting the cases amenable to these approaches is just as important as his or her skill in performing the surgery.
Is the surgery painful?
A certain amount of incisional pain is to be expected with any surgery. Because there is less manipulation of the soft tissue overlying the bone, patients often find these procedures less painful than “conventional” skull base surgeries.
Patients undergoing endoscopic endonasal approaches (see below) complain of discomfort in their nose and sinuses.
How big is the incision?
Minimally invasive approaches are performed through incisions a few inches in length that can be hidden in the folds surrounding their eyes or behind their hairline.
Endoscopic endonasal approaches are performed through the nose and do not involve a visible incision on the face or head.
How long will I be in the hospital?
The recovery from each surgery varies based on the length of the surgery and the overall health of the patient. Straightforward surgeries typically involve 2-3 days of inpatient hospitalization for post-operative monitoring.
When can I return to work?
There may be lifting restrictions for 4-6 weeks following the surgery, depending on the surgery performed. Swelling of the eye also may last a couple of weeks following surgery in this area. Unless your job requires heavy lifting, you may return to work as soon as you feel up to it. This may be as soon as a few days after the surgery, or as long as several weeks.
What do I need to do after the surgery?
Some patients require outpatient or inpatient rehabilitation following these surgeries. Your recovery often depends on your effort and compliance with these therapies.
Follow up is critical following any type of surgery. Most serious complications can be managed easily if detected in a timely fashion. In the long term, your compliance allows us to follow and treat any recurrence and determine the efficacy of our surgical interventions.
As this follow up may involve visits with multiple physicians, our team of care providers and support staff will help coordinate your visits.
What is "endoscopic endonasal" surgery?
“Endoscopic” skull base surgery utilizes a light at the end of a long, narrow tube attached to a camera instead of a microscope to visualize the surgical field. Because of its small size, the endoscope can be placed close to the target to visualize areas that may be invisible to a microscope.
“Endoscope-assisted” surgeries refer to surgeries in which the endoscope is used as an adjunct to a conventional skull base approach with the goal of avoiding unnecessary expansion of that approach.
“Fully endoscopic” surgeries refer to surgeries performed completely with the endoscope.
The “endoscopic endonasal” approach for tumors of the pituitary and the surrounding regions is the most common example of this approach. This approach may be expanded to reach a variety of tumors located in the area of the skull base behind the face and nose without requiring a large incision. In some cases, it can decrease the amount of brain and nerve manipulation required to effectively reach a deep-seated lesion.
Is this surgery safe?
This surgery is safe and effective if performed by a well-trained surgical team skilled in these approaches. Endoscopic surgeons must develop a skill set different from conventional surgeons in order to be comfortable with these techniques. They also must be skilled at determining which conditions are best treated by these approaches.
Is the surgery painful?
Although the surgery does not involve an incision in the scalp or face, discomfort in the nose and sinuses is a common occurrence following endoscopic endonasal approaches. These symptoms usually improve a few weeks after the surgery.
How big is the incision?
There is no incision on the face or scalp for endoscopic endonasal surgeries. A small incision on your abdomen or thigh is necessary in some cases to obtain fat for reconstruction.
How long will I be in the hospital?
An uncomplicated endoscopic endonasal approach for removal of a pituitary tumor requires one or two days of hospitalization. Longer stays may be required to manage problems related to the pituitary gland. Some patients go home the day after surgery.
More complex surgeries can require several days of hospitalization.
When can I return to work?
Following endoscopic endonasal approaches, there are lifting restrictions for 4-6 weeks following the surgery. Patients with jobs that do not require heavy lifting may return to work as soon as they feel ready.
What do I need to do after the surgery?
“Endoscopic endonasal” approaches require follow-up with multiple specialists. In the immediate post-operative period, an otolaryngologist must regularly clean out your nasal passages. If your condition involved a problem with your hormones either before or after surgery, an endocrinologist may need to place you on medications to treat these problems.
The neurosurgery team will periodically order imaging to check for tumor regrowth.
Our team of care providers and support staff will help coordinate your visits.
Which type of surgery should I have?
The type of surgery depends on the goals of surgery and the expertise of the surgical team. Advances in radiation therapy and radiosurgery, as well as medical modalities, have decreased the need for complete surgical resection of some skull base tumors. Complete surgical resection, in some cases involves a high risk of damage to the nerves that help you see, smell, taste, hear, swallow and feel and move your face.
While it has certain advantages, “minimally invasive” should not be “minimally effective” which is a risk if the surgeon is not comfortable with the procedures and their indications. The same principle applies to endoscopic approaches.
Every surgical approach comes with its own set of unique side effects and potential complications, which are minimized with training and experience. The risks and benefits must be carefully discussed with your surgeon.
Do I need surgery?
There are many tumors and other conditions of the skull base that may be followed for years with serial imaging before needing treatment, if treatment is ever warranted. Other treatment modalities such as medication or radiation also may be as effective as surgery without the accompanying risks. Your health care providers can help you determine which of these options is best for you.
