Tumors of the skull base

Thomas J Wilson MD (Dr. Wilson of the University of Michigan has no relevant financial relationships to disclose.)
Sandra Camelo-Piragua MD (Dr. Camelo-Piragua of the University of Michigan has no relevant financial relationships to disclose.)
Jason A Heth MD (Dr. Heth of the University of Michigan has no relevant financial relationships to disclose.)
Matthew Lorincz MD PhD, editor. (Dr. Lorincz of the University of Michigan receives salary support from Wilson Therapeutics AB for performing UWDRS examinations in a clinical trial.)
Originally released December 22, 1999; last updated January 6, 2014; expires January 6, 2017

Overview

Key points

• Skull base tumors originate from a broad range of tissues that develop into a wide array of tumors of varying biological behaviors.

• Each skull base location has a relatively defined differential diagnosis in terms of neoplasms; however, the differential diagnosis can differ significantly between tumors located at different sites within the skull base.

• Magnetic resonance imaging is the gold standard for determining anatomic details of skull base tumors whereas CT imaging and angiography provide supplementary information in appropriate clinical circumstances.

• Tumor histology and identification strongly influence overall prognosis for each skull base tumor type.

• Tumor location is a primary determinant of surgical approach, which is further refined by the likely tumor type.

Historical note and terminology

The history of skull base surgery begins with pioneers in otolaryngology and neurosurgery. Sir Charles Balance and Harvey Cushing both had a special interest in acoustic neuromas. Additionally, Harvey Cushing devoted his tremendous intellect and energy toward the surgical treatment of pituitary tumors and meningiomas, making this "father of neurosurgery" also the father of skull base surgery.

Interdisciplinary cooperation for treatment of skull base tumors started at the University of Mainz nearly 30 years ago (Samii 1994). Since then, multidisciplinary skull base teams composed of neurosurgeons, otolaryngologists, plastic surgeons, ophthalmic surgeons, and radiologists have been created and have thrived. Early institutional leaders in this cooperative approach included the University of Pittsburgh, the Barrow Neurological Institute, the Mayfield Institute in Cincinnati, the University of Florida at Gainesville, and the University of Hannover in Germany. Several excellent textbooks on the subject have resulted (Fisch and Mattox 1988; Dolenc 1989; Samii and Ammirati 1992; Sekhar and Janecka 1993; Samii 1994). In 1990, the journal Skull Base Surgery was created. This is the official journal of the North American Skull Base Society, German Skull Base Society, Korean Skull Base Society, European Skull Base Society, and Japanese Skull Base Society.

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