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Which Types of Diseases Are Treated With Skull Base Surgery?
A variety of benign tumors are treated with skull base surgery. These include acoustic neuroma, meningioma, schwannoma, glomus jugulare and vagale, epidermoid, pituitary tumors, and many others. Malignant tumors managed with skull base surgery include squamous cell carcinoma, esthesioneuroblastoma, chondrosarcoma, chordoma, and endolymphatic sac tumors. Occasionally, particularly in the pediatric population, a skull base biopsy may be required in order to diagnose other diseases such as leukemia, lymphoma, plasmacytoma, Langerhans’ dell histiocytosis, rhabdomyosarcoma, osteosarcoma, fibrosarcoma, hemangiopericytoma, malignant fibrous histiocytoma, or metastatic disease. Skull base surgical techniques are also sometimes employed to repair fractures of the skull base, to treat cerebral aneurysms, as well as to remove deep-seated infections of the skull base bone.
What type of symptoms do patients with skull base tumors have?
Tumors arising within the skull base are rare and usually cause few symptoms until they grow to a size where they begin to affect neurologic function. These symptoms may manifest as double vision, facial pain or twitching, hearing loss, loss of balance or dizziness, hoarseness, or tongue weakness. Occasionally, an asymptomatic tumor may be diagnosed when a middle ear mass is noted during routine examination of the ears.
How is a skull base tumor diagnosed?
An MRI of the brain and/or skull base with and without gadolinium contrast is extremely sensitive at diagnosing these rare tumors with little risk to the patient. A CT scan of the skull base or temporal bone may also be needed to evaluate the condition of the surrounding skull base bone. Occasionally, an MRA or MRV (magnetic resonance angiogram and magnetic resonance venogram) are useful to study how the blood vessels to the brain are affected by the tumor. For large or very vascular tumors, an angiogram with embolization may be performed prior to surgical resection in order to plug the arteries that feed the tumor. This reduces blood loss during surgery.