Skull Base Program

Approximately one in ten adults have an abnormality of the pituitary gland. Most are found incidentally, are benign, and can be monitored over time with no surgical intervention. One reason why a surgeon may offer a surgical procedure could be if the tumor is big enough to press on nearby structures and cause issues with vision or a decrease in normal pituitary function. Another reason for offering a surgical intervention would be if the tumor is causing an over secreting of a pituitary hormone that is in turn causing you harm. Over secretion of pituitary hormone ACTH or adrenocorticotropic hormone causes Cushing’s Disease which can lead to diabetes and heart disease and thereby shorten your lifespan. Over production of pituitary hormone IGF-1 or insulin-like growth factor 1 causes acromegaly in adults or gigantism in childhood. Acromegaly shortens lifespan with complications like high blood pressure, diabetes, and enlargement of soft tissues including the heart (cardiomyopathy).

While there are multiple ways to access the pituitary gland our Skull Base Program physicians specialize in accessing the anterior skull base or “anterior fossa” using the transnasal approach. This means that they use an endoscope or long camera and delicate instruments to go through the nasal passages and sinuses. There is no visible craniotomy scar.

Acoustic Neuromas and vestibular schwannomas are in essence two names for the same tumor. These tumors grow off the sheath or outer covering of the cranial nerves that assist with hearing and balance. Tumors in this region can happen on either the right or left side of the head, are usually benign, and typically cause mild to complete hearing loss and difficulty with balance due to vertigo and dizziness.

While watchful waiting with surveillance imaging may be an option for some tumors, others may require surgical intervention. Access to the lateral skull base or “middle fossa” can be gained through hearing sparing approaches like retrosigmoid or transtemporal craniotomy. Translabrynthine approach craniotomy does not spare hearing. These approaches all require a visible incision.

Enchephaloceles are described as an outpouching of the outer covering of the brain and sometimes brain tissue through a defect in the skull base. These defects can be due to trauma, individual anatomy, or high intracranial pressure. Sometime the defect in the skull base is sharp and may puncture the outer covering of the brain or the “dura” causing a CSF leak. CSF or cerebrospinal fluid is created by your brain and bathes the brain and spinal cord. Your brain creates about ½ quart of CSF daily and reabsorbs it but if there is a hole in the dura it can leak out. People with CSF leaks may notice that they have thin, clear, salty fluid leaking from their noses, their ears, or down the back of their throats. Depending on where the skull base defect is you may be at increased risk for seizures and infections like meningitis.

Treatment for CSF leaks and encephaloceles almost always requires surgical intervention. Access or approach depends on of the defect is in the anterior or lateral skull base. Your skull base specialists will need to patch the hole created in the outer covering of the brain and rid the defected bone of the sharp edges that created the puncture.

Meningiomas are a mostly benign type of tumor the grows from the outer covering of the brain and spinal cord. Small meningiomas may be left alone to watch over time and assess for growth if they are not putting pressure on any other important structures. If a meningioma is putting pressure on an important structure like the optic nerves or blood vessels or if it is growing at a rapid rate your surgeon may encourage surgery to remove it. If a meningioma grows large enough to cause swelling in the brain around the tumor or if it causes seizures your surgeon will strongly encourage surgery.

Meningiomas can occur anywhere on the outer covering of the brain. Therefore surgical treatment of meningiomas can involve numerous techniques to gain access to the tumor including transnasal or anterior, retrosigmoid or lateral, and suboccipital or posterior craniotomies among other non-skull base approaches.