Tumors of the skull base

Melanie Hayden Gephart MD MAS (Dr. Gephart of Stanford University School of Medicine has no relevant financial relationships to disclose.)
Ali Fatemi MD (Dr. Fatemi of Johns Hopkins School of Medicine has no relevant financial relationships to disclose.)
Matthew Lorincz MD PhD, editor. (Dr. Lorincz of the University of Michigan has no relevant financial relationships to disclose.)
Originally released December 22, 1999; last updated October 15, 2018; expires October 15, 2021

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, varying greatly depending on the anatomic site.

 

• Magnetic resonance imaging and CT provide the necessary anatomic details of skull base tumors.

 

• Tumor histology and location strongly influence overall prognosis for each skull base tumor type, and determines treatment approach.

Historical note and terminology

Skull base tumors are located in the vicinity of the brainstem or beneath the cerebral cortex, making their treatment technically challenging. Skull (cranial) base surgery has been driven by pioneers in neurosurgery and otolaryngology. Sir Charles Balance and Harvey Cushing both had a special interest in vestibular schwannomas. Interdisciplinary cooperation for treatment of skull base tumors started at the University of Mainz many years ago (Samii 1994), and consists of neurosurgery, otolaryngology, plastic surgery, ophthalmology, radiation oncology, and neuroradiology. This clinical focus has been represented by formal journals (eg, Skull Base Surgery created in 1990 and is available as part of the Journal of Neurological Surgery Part B – Skull Base as of 2012), and skull base societies.

Until recently, many deep seated, skull base tumors were either entirely inoperable or could be exposed by damaging normal brain structures. This could result in brain injury affecting movement, feeling, speech, mental abilities, and other adverse neurologic consequences. The basic concept that underlies cranial base surgery is removal of bone, often in a clever and anatomically complex manner, to reduce or even eliminate the need for brain retraction. Skull base procedures, for example, may be designed to traverse the bone containing the ear (petrous bone), around the eye (orbit), through the nose or paranasal sinuses, low on the temple beneath the brain, or even upwardly directly from the neck region. Fundamentally, these are techniques afford the highest possible degree of tumor removal while preserving neurologic function to the greatest extent possible. Adjuvant treatments and advances in stereotactic radiosurgery have allowed skull base surgeons to enable more safe and effective treatments.

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