Skull Base Surgery

Skull Base Surgery

What is Skull Base Surgery?

Skull base surgery is a specialised field of surgery that focuses on treating various conditions and tumours located at the base of the skull. This area is complex and houses vital structures such as blood vessels, nerves, and important brain structures. Skull base surgery aims to remove tumours, repair defects, or treat abnormalities in this region while minimising damage to surrounding healthy tissues and preserving neurological function.

When is Skull Base Surgery Recommended?

Skull base surgery may be indicated for various conditions affecting the structures located at the base of the skull. Some common indications for skull base surgery include:

• Skull Base Tumors: Surgery may be necessary to remove tumours that originate in or extend to the skull base. These tumours can be benign (non-cancerous) or malignant (cancerous), and the type and location of the tumour determine the surgical approach. Common skull base tumours include:
  • Meningiomas
  • Pituitary Tumours
  • Schwannomas
  • Chordomas/chondrosarcomas
  • Sinonasal, orbital and head and neck cancers
• Cerebrospinal Fluid Leaks: Skull base surgery may be performed to repair leaks of cerebrospinal fluid (CSF) that occur due to trauma, surgery, or spontaneous causes.
• Trigeminal Neuralgia and Hemifacial spasm
• Vascular Abnormalities: Skull base surgery may be performed to treat certain vascular abnormalities, such as arteriovenous malformations (AVMs) or aneurysms, which can pose risks of bleeding or neurological deficits if left untreated.

How Should I Prepare for Skull Base Surgery?

• Discuss the procedure, risks, benefits, and expected outcomes with your surgical team.
• Sign consent form.
• Attend all preoperative appointments and imaging studies.
• Inform your doctor about medications, allergies, and medical conditions.
• Stop certain medications, such as blood thinners, supplements, and fish oil.
• Follow fasting instructions carefully.
• Arrange transportation and support for recovery.

What Happens During Skull Base Surgery?

In general, the procedure for a skull base surgery may involve the following steps:

• You will typically be given general anaesthesia to ensure you are unconscious and pain-free throughout the procedure.
• There are different surgical approaches to the skull base, including endoscopic (minimally invasive) techniques and traditional open surgery. The choice of approach depends on factors such as the location and size of the lesion, the need for access to specific structures, and the expertise of the surgical team.
• If the surgery is endoscopic, the nose forms the access point and a thin, endoscope with a camera and light source is used to navigate and visualise the skull base structures.
• In open surgery, larger incisions are made in the scalp and in the skull to directly access the skull base.
• Once access is gained to the skull base, the surgical team will proceed with the main objective, which could be tumour resection, repair of defects, treatment of vascular abnormalities, or other interventions depending on the condition being addressed. Surgical tools such as microscopes, endoscopes, and specialised instruments are used to carefully remove tumours, repair tissues, or address abnormalities while preserving important structures like nerves and blood vessels.
• Throughout the surgery, various monitoring techniques may be used to ensure the safety and efficacy of the procedure. This may include neurophysiological monitoring (to monitor nerve function), and continuous vital signs monitoring.

What Happens After Skull Base Surgery?

After skull base surgery, patients are monitored in the intensive care unit for complications such as swelling, bleeding, or neurological changes. Doctors assess speech, movement, memory, nerve and overall brain function. Pain medications and steroids may be prescribed. Imaging scans are performed the next day to evaluate tumour removal. Recovery time varies, and rehabilitation may be needed for some patients. Depending on pathology results, additional treatments like radiation therapy, chemotherapy or newer targeted therapies may also be recommended.

What are the benefits of Skull Base Surgery?

• Removes as much of the tumour as safely possible.
• Relieves symptoms such as headaches, and neurological deficits.
• Reduces pressure on skull base structures.
• Provides tissue for accurate diagnosis and treatment planning.
• May improve survival and enhance the effectiveness of radiation and chemotherapy

What are the Risks and Complications of Skull Base Surgery?

Risks and complications associated with skull base surgery may include and depend very much on the location and the type of problem:

• Post op haematoma
• Infection (brain, CSF, wound, urine, chest)
• Cerebrospinal fluid (CSF) leak
• Nerve damage which may cause:
  • Hearing loss
  • Dizziness/vertigo
  • Facial paralysis
  • Facial numbness
  • Difficulty with swallow, cough and voice
  • Double vision
  • Loss of vision
  • Loss of smell sense
• Brainstem or vascular injury leading to stroke
• Hydrocephalus (accumulation of brain fluid)
• Complications related to other medical conditions (heart, lungs, kidney)
• Clots in legs (Deep venous thrombosis) and clots in lungs (pulmonary embolus)
• Reactions to anaesthesia.

Note: Your surgeon will advise you on how likely the above complications are.

What can I expect when I am discharged from hospital

• You may experience pain (including headache), inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• Keep the surgical site clean. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking and alcohol until your first follow up visit as it can negatively affect the healing process.
• Refrain from lifting anything heavier than 5 Kg and other strenuous activities until the first follow-up visit. These activities may include housework, yard work, gardening, mowing, etc.
• Gentle exercise and regular walking are recommended to improve strength and endurance from 2 weeks after surgery.
• Refrain from driving until you are fully fit and receive your surgeon’s clearance.
• Most patients can return to their normal daily routines in 4-6 weeks after surgery.