Skull Base Surgery

What Is Skull Base Surgery?

Skull base surgery is surgery that is done to remove a tumor or other growth at the base, or bottom, of the skull.

Minimally invasive skull base surgery, also called endoscopic skull base surgery, is a surgical technique that lets doctors do this delicate surgery through the nose.

Why Is Skull Base Surgery Done?

Skull base surgery is done to remove tumors, including:

• craniopharyngiomas (a brain tumor near the pituitary gland )
• tumors in the pituitary gland
• sinonasal tumors (tumors of the sinuses and nasal cavities)

Skull base surgery also can be done to treat a cyst , encephaloceles (hernias in the brain), and some birth defects.

What Happens Before Skull Base Surgery?

Caring for children with tumors and other conditions that need skull base surgery takes a team. Depending on a child's diagnosis, the care team of doctors may include:

• an ear, nose, and throat surgeon (ENT)
• a neurosurgeon
• an ophthalmologist
• an anesthesiologist
• an endocrinologist
• an oncologist
• a radiologist

To prepare for surgery, doctors will likely order a CAT scan and/or an MRI scan. A child may need other tests, treatments, and exams before surgery.

How Is Minimally Invasive Skull Base Surgery Done?

A child gets anesthesia to sleep through the procedure. The surgeon will insert a thin tube with a light and high-definition camera — called an endoscope — in the nose. Then, the surgeon uses special tools to remove the tumor or other growth. The endoscope lets the surgeon see the area clearly during the procedure.

How Long Does Skull Base Surgery Take?

How long the surgery takes depends on a child's condition. Usually, it takes several hours.

What Happens After Minimally Invasive Skull Base Surgery?

Doctors will put absorbable packing material in the nose to help control bleeding. The doctor will recommend saline (saltwater) nasal spray and antibiotic ointment to help keep the inside of the nose moist and minimize crusting.

After surgery, a child will see the ENT surgeon regularly. The surgeon will check healing and clean up crusting in the nose.

Depending on the diagnosis, a child also might have follow-up visits with other specialists and other treatments, such as radiation or chemotherapy.

Kids must avoid things that increase pressure in the head for at least a month after skull base surgery. They should not:

• strain or bear down (like during a bowel movement). The doctor may recommend a stool softener.
• blow their noses hard
• sneeze with their mouth closed
  
• sleep flat. The doctor will usually recommend sleeping with a couple of pillows to keep the head elevated for a week or two.

Are There Any Risks From Skull Base Surgery?

The most common problem after skull base surgery is a cerebrospinal fluid (CSF) leak. CSF, the clear fluid that surrounds and cushions the brain, can leak out of the nose if there is a hole or tear in the protective covering of the brain. CSF leaks must be repaired.

There also is a chance of injury to blood vessels or important nerves at the base of the skull during surgery.

Other complications of skull base surgery can include:

• bleeding
• loss of smell
• decreased sense of taste
• face and teeth numbness
• meningitis or other infection

What Else Should I Know?

The conditions treated with skull base surgery are serious. Minimally invasive skull base surgery allows for faster recovery, less pain, no scars, fewer complications, and less chance of damage to other parts of the brain. In some cases, though, traditional skull base surgery can be the better option.

If you have questions about your child's surgery, talk to your doctor.