Expert Multidisciplinary Treatment for Skull Base Tumors and Disorders
The nationally recognized ear, nose and throat experts at University Hospitals have the advanced medical and surgical training to diagnose and treat a wide range of skull base conditions. All rhinologists (sinus/nasal), otologists (ear), and head & neck reconstructive surgeons at University Hospitals have completed fellowships in their respective subspecialties. Fellowships are additional training that ENT providers can complete to obtain a higher level of proficiency in one particular area within otolaryngology.
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What are Skull Base Disorders?
Skull base disorders is a broad term used to describe conditions that are found at the base or side of the brain. Pathologies found at the base can be approached surgically through the nose (anterior approach) and issues on the side can be approached in and around the ear (lateral approach). As technology and expertise have progressed, more advanced procedures can now be performed safely. A major focus of this type of surgery is a minimally invasive approach with the goal of improving patient outcomes and quality of life following the procedures.
Some of the more common skull base conditions we diagnose and treat, include:
Advanced Diagnostic Techniques for Skull Base Pathologies
If you have been diagnosed with a skull base lesion at the base of your brain, your work-up will likely include nasal endoscopy and imaging tests (CT and/or MRI). Nasal endoscopy is performed in the clinic setting and involves the insertion of a small scope into the nose to visualize the structures within the nasal cavities and, in some cases, the lesion of concern. CT or computed tomography is used to gain a high resolution image of the bones of the skull and can be used for image guidance during the procedure. Image guidance allows three-dimensional tracking during surgical procedures to pinpoint location and identify critical structures before they are encountered. MRI or magnetic resonance imaging allows for a high resolution image of soft tissues that can differentiate normal from abnormal structures.
If you have been diagnosed with a skull base lesion in or around your ear, your work-up will likely include a microscopic examination of your ear in the clinic setting, hearing test (audiogram), and CT and MRI imaging tests. The hearing test is used as a baseline assessment of hearing function prior to any intervention and imaging is used to define components of the lesion as outlined previously.
Advanced Minimally Invasive Treatments
Optimal management of skull base pathology requires a multidisciplinary team. Depending on the type of issue, it could be treated with watchful waiting, ongoing imaging tests to monitor the condition or medical therapy. In some cases, more definitive treatments such as surgery or radiation are required. At University Hospitals, our skull base teams come together to discuss each case to determine the best way to treat each patient, incorporating the expertise of multiple providers and specialties to arrive at the best possible plan.
Depending on the type and location of the disorder, the surgical approach will vary. For lesions along the base of the brain or in the sinuses or nasal cavities, the optimal approach is through the nose. The ENT team opens the sinuses and creates a pathway to the region of concern. In most cases, this is exactly what is done in traditional sinus surgery. In conjunction with neurological surgery, the procedure is completed and the reconstruction is performed jointly. The major advantage of this type of surgery is that it minimizes unnecessary manipulation of the brain. Often the distance between the tumor and the sinus itself is just millimeters, making this route the most direct approach.
For tumors involving the skull base in and around the ear, the approach is either through or around the ear itself. The ENT team creates a pathway to the lesion of concern. There are many considerations that go into choosing the appropriate approach, including the location and size of the tumor. The tumor resection and reconstruction is performed jointly with neurosurgery.
In some cases, surgery alone is not the best option and radiation therapy is offered either as primary treatment or in conjunction with surgery. We have state-of-the-art facilities for delivery of this treatment at University Hospitals including Gamma Knife. UH also has proton therapy treatment capabilities. These technologies allow for targeted treatment of tumors in and around the brain, with minimal damage to healthy surrounding tissue.
Our Multidisciplinary Teams
Serves as a single point of contact to assist in scheduling appointments, answering patient questions, and leading our research efforts as we continue to innovate and expand our services.
Multidisciplinary Teams Provide Optimal Outcomes
If surgical intervention is recommended, our UH fellowship-trained ENT specialists work hand-in-hand with our neurosurgery partners. Surgically, care may also involve oculoplastic surgery (specialists who work with the eye and associated structures), interventional radiology or reconstructive surgeons.
Our medical management team includes ophthalmology, endocrinology, radiation oncology, medical oncology, speech and language pathology, audiology, nutrition and pain management.
As part of our continued effort to provide not only the highest quality of care but also to improve our patients’ experience during their treatment, the ENT department has a skull base surgery coordinator who serves as a single point of contact to assist in scheduling appointments, answering patient questions, and leading our research efforts as we continue to innovate and expand our services. This will improve the level of communication between provider and patient and limit the patient stresses that are often associated with navigating a complicated health care environment.
Ongoing Support and Care through Recovery and Beyond
Throughout your care path, we will work with you every step of the way to keep you informed. Treatment of skull base conditions often requires long-term care from initial recovery to the transition to long-term surveillance. We look forward to working with you and meeting your needs as our patients.