Skull base surgery involves treating diseases, such as tumors, in some of the hardest-to-reach areas of the human body. Until recently, many skull base tumors were considered inoperable because accessing the tumor during surgery was more risky than the tumor itself. The field of skull base surgery was created to develop and utilize specialized pathways to reach these tumors without damaging critical structures along the way.
The skull base includes structures that sit within the bone behind the eyes, behind the nose, and deep to the ears. The anatomy is incredibly complex and involves dense arrangements of blood vessels, important nerves, the brain, and sensory structures (such as for smell, vision, balance, and hearing).
In the early years of skull base operations, big or invasive incisions were required. Next, large segments of bone would be drilled away, or removed for later replacement. The brain would sometimes then need to be retracted in order to see the pathology. These traditional approaches allowed good exposure to see and remove tumors. Unfortunately, the recovery from the approach to the tumor was sometimes worse than from the tumor removal itself.
Today, many skull base tumors are taken out using less invasive approaches. For example, tumors of the pituitary gland and adjacent regions may be removed entirely through the nose without any skin incisions.
These advances are due to improvements in surgical instrumentation, imaging, and training. Endoscopes with high-resolution cameras allow detailed views of the surgical field even when the disease is located deep within the head, eliminating the need for creating larger openings in the body. Increased collaboration between specialists, such as otolaryngologists and neurosurgeons, has also led to innovative new approaches.
Skull base surgeons at Columbia employ the latest techniques and have access to the most advanced technology to reach and remove complex skull base tumors. There is also active effort to expand minimally invasive techniques to include more and more types of skull base tumors.