Lesions located in or around the base of the skull are very difficult to treat surgically due to their locations. With a multi-disciplinary team approach and innovative surgical techniques, however, our experts are better able to remove deep-seated intra- and extra-cranial skull base lesions—allowing patients a better quality of life.
Surgery on skull base tumors combines the highly specialized techniques of interventional neuroradiology, otolaryngology, neurosurgery, ophthalmology, plastic surgery, and neuroanesthesiology. The principal goal of skull base surgery is to permit access to difficult-to-reach lesions by anatomic displacement or extensive removal of the base of the skull. These techniques reduce or eliminate the need for brain retraction, thereby minimizing injury to the brain, cranial nerves, and blood vessels.
Our Skull Base Tumor Program, established in 1993, has become one of the largest benign brain tumor programs in the nation, treating over 200 new patients with meningioma and schwannomas annually.
Types of Skull Base Tumors & Lesions
Skull base surgical techniques are commonly used to treat various brain tumors and lesions in or around the paranasal sinuses and the floor of the anterior fossa, orbit, infratemporal fossa, sella, clivus, cavernous sinus, temporal bone/petrous apex, posterior fossa, and the foramen magnum region.
Cleveland Clinic’s Skull Base Surgery Program offers many options for brain tumor treatment. We treat the following brain tumors and lesions.
- advanced head and neck tumors
- cholesteatomas/cholesterol granulomas
- fibrous dysplasias
- glomus tumors
- invasive/giant pituitary tumors
- orbital tumors
- paranasal sinus tumors
- pharyngeal neoplasms
- temporal bone tumors
Vascular & Congential Lesions
- arterio-venous malformations
- basilar invaginations
- carotico-cavernous fistulae
- cavernous angiomas
- complex aneurysms
- congenital cysts
- craniofacial malformations
- complex craniofacial fractures
- CSF rhinorrhea
- orbital apex fractures with optic nerve compression
Consultation & Evaluation
Physicians seeing patients with skull base pathology or problems are encouraged to seek a consultation with one of our specialists. The Skull Base Surgery Program at Cleveland Clinic provides second opinions as well as surgery for recurrent or residual lesions. In addition, we have extensive experience managing high-risk patients with multiple medical problems.
Following an initial evaluation – which includes a medical history and complete physical, neurological, otolaryngological, and ophthalmological examinations as well as comprehensive radiographic studies - members of the Skull Base Surgery Program meet to develop a plan tailored to the individual patient’s needs.
If surgery is deemed appropriate, specific surgical options are evaluated including anticipated closure and reconstruction of complex operative wounds. Post-operative rehabilitation and adjunct treatment modalities are discussed as needed. All recommendations are then discussed with the patient, family members and the referring physician.
Complete pre-operative testing is critical to the success of these intricate procedures, and the Skull Base Surgery Program uses high-resolution CT, MRI, MRA and standard angiography to accurately delineate the skull base pathology.
To improve the safety and outcome of skull base surgery, Cleveland Clinic specialists utilize a number of sophisticated interventional neuroradiological procedures. These include selective embolization to decrease tumor vascularity and reduce intraoperative blood loss and carotid artery test occlusion to evaluate the brain’s tolerance to carotid artery occlusion during surgery. In tumors located near or invading the carotid artery, this information is critical, as it will allow surgeons to either limit the extent of tumor resection to prevent major stroke, or to perform radical removal of the tumor and the involved artery. Selected patients who do not tolerate the test occlusion of the carotid artery may be advised to undergo a bypass procedure prior to resection to allow radical tumor removal.
Specialists in the Skull Base Surgery Program utilize state-of-the-art technology and equipment, including frameless/stereotactic sonic wand, intraoperative monitoring, specialized neuroanesthetic techniques, intraoperative angiography/embolization, laser, profound hypothermia/circulatory arrest, and stereotactic radiosurgery.
Throughout the evaluation process, treatment and recovery, referring physicians and family members are kept informed by telephone and/or written correspondence.
Inoperable Brain Tumors
When brain surgery is not the treatment of choice, or if adjunct therapy is recommended in addition to brain surgery, patients have available to them comprehensive radiation therapy and chemotherapy services. Our patients also have access to numerous clinical trials, some designed by Cleveland Clinic physicians, others as a part of multi-center trials in partnership with pharmaceutical companies or research consortia.
The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center actively participates in several of these groups, including New Approaches to Brain Tumor Treatments (NABTT), the Southwest Oncology Group (SWOG), the Radiation Therapy Oncology Group (RTOG), the American College of Surgeons Oncology Group (AcoSOG), and the Children's Oncology Group (COG). These associations contribute to the exciting environment of discussion and the sharing of data that is so important to the dynamic evolution of the therapeutic protocols of tomorrow.
A 41-year-old female presented with headaches, nausea and dizziness. The MRI showed a high signal intensity lesion on T1, with minimal enhancement, located in the clival region anterior to the brainstem. This neurenteric cyst was totally resected via the combined transpetrosal and retrosigmoid approaches. The patient had transient right VI cranial nerve palsy which resolved.
A 15-year-old presented with nasal stuffiness. MRI scans following gadolinium injection showed a large mass involving the maxillary, sphenoid and ethmoid sinuses, as well as the pterygopalatine fossa and the parapharyngeal space. The tumor also invaded the anterior aspect of the cavernous sinus and middle fossa. A combined otolaryngeal/neurosurgical skull base procedure was performed to achieve total resection of this juvenile angiofibroma. The patient did well postoperatively with no neurologic deficit other than V2 distribution numbness.
A 58-year-old female presented with a large meningioma involving the right cavernous sinus and the petroclival region. The cavernous sinus portion was removed totally in one stage, and the petroclival tumor was removed subtotally via a separate transpetrosal approach. The patient is doing well, and right cranial nerve palsies involving III, IV, V, VI, and VII are resolving.