Find Effective Treatment for Skull Base Tumors at Raleigh Neurosurgical Clinic
What Are Skull Base Tumors?
A skull base tumor is a rare growth of abnormal cells located inside or outside the skull base, the bones that form the floor of the skull. They can be cancerous (malignant) or non-cancerous (benign), and they can either begin in the skull base or result from cancer that has spread (metastasized) from another part of the body.
The spinal cord, numerous nerves, and blood vessels pass through the skull base, making it a complex structure. Additionally, tumors that grow in this area can affect critical functions such as sight, hearing, and balance.
For this reason, patients with skull base tumors should be diagnosed and treated by specialists who have expertise in this area, such as the team at Raleigh Neurosurgical Clinic. Make an appointment today or contact our nurse navigators.
What Causes Skull Base Tumors?
The cause of skull base tumors is not clear. However, doctors have identified some risk factors, including certain inherited conditions, exposure to dangerous chemicals, and past radiation therapy to the head, neck, or brain.
What Are the Types of Skull Base Tumors?
Common types of skull base tumors include:
- Adenocarcinoma: Cancer that forms in mucus-secreting glands in the body.
- Adenoid cystic carcinoma: A malignant tumor that starts in the salivary glands.
- Cholesteatoma: A noncancerous growth that occurs in the middle ear.
- Chondrosarcoma: A type of cancer that develops in cartilage cells.
- Chordoma: A slow-growing bone cancer that may begin in the base of the spine or the skull base.
- Glomus tumor: A tumor of the temporal bone, a structure that contains the middle and inner portions of the ear; usually benign.
- Meningioma: A benign, slow-growing tumor that develops in the membranous coverings of the brain (meninges).
- Neurofibromatosis type II (NF2): A group of genetic disorders that causes tumors to develop in the brain, spinal cord, and nerves; usually benign. This disorder causes bilateral acoustic/vestibular schwannomas. NF2 is hereditary, with a 50% chance of genetic transmission. Since these tumors affect the acoustic nerve, hearing is affected and usually patients eventually go deaf. Additionally, multiple meningiomas can form in the brain and/or spine.
- Pituitary tumor: A noncancerous tumor that develops in the pituitary gland, a small, bean-shaped gland at the base of the brain. Many pituitary tumors cause no symptoms and are incidentally found. Some pituitary tumors are symptomatic and can secrete hormones such as:
- Growth hormone, causing acromegaly or gigantism
- Prolactin, resulting in a prolactinoma; this can cause irregular and absence of menstruation or milk leaking from your breasts, even if you are not pregnant or nursing
- ACTH, which can cause Cushing’s disease and/or disorders of metabolism
Some pituitary tumors produce no hormones at all, resulting in a non-secreting pituitary tumor. Pituitary tumors can grow large and affect vision.
- Schwannoma (acoustic/vestibular neuroma, facial nerve neuroma, trigeminal nerve neuroma): Tumors, usually benign, that develop from a type of glia (non-neuronal cell) in the tissue that covers nerves; these nerves control balance and hearing, facial sensation, or motor functions.
- Sinus and nasal cavity tumors: Tumors that occur in the nose or sinuses, which may be benign or malignant.
Conditions other than tumors can affect the skull base. These are often referred to as cranial base disorders.
What Are Some Types of Cranial Base Disorders?
Common cranial base disorders that we treat include:
- Glossopharyngeal neuralgia: A very rare pain disorder of the glossopharyngeal nerve, which causes severe pain in the throat, tongue, ear, and tonsils. Precise medical history and magnetic resonance imaging (MRI) imaging is essential for proper diagnosis. Treatment options include medical management or microsurgical intervention.
- Hemifacial spasm: A disorder caused by neurovascular or blood vessel compression of the facial nerve, which makes one side of the face twitch involuntarily. Diagnosis of hemifacial spasm can be challenging because there are many facial movement disorders, so a very careful and detailed medical history should be taken in addition to obtaining MRI imaging. Treatment options include Botox or microsurgical intervention. Oral medications are rarely effective for hemifacial spasm.
- Trigeminal neuralgia type 1 (typical): An episodic, severe, and excruciating pain disorder caused by neurovascular or blood vessel compression of the trigeminal nerve, a large, complex cranial nerve that controls motor and sensory function of the face. The pain feels like electric shock pains to the face, mostly the cheek and jaw, that come and go and are provoked by triggers such as touch, wind, toothbrushing, talking, and chewing. Over time, pain progresses and the duration of pain-free periods decreases; attacks become more severe and medications become less effective. There are many types of facial pain, so a detailed and precise medical history as well as MRI imaging are essential for proper diagnosis.
- Trigeminal neuralgia type 2 (atypical): A chronic, constant, aching-with-pressure, burning facial pain, often accompanied by tingling and numbness. This facial pain disorder of the trigeminal nerve can have many causes, such as the herpes zoster virus attacking the trigeminal nerve or damage to the trigeminal nerve by demyelination (loss of the protective tissue that protects the trigeminal nerve). There are usually no triggers that provoke pain and medications are often not fully effective.
- Other causes for trigeminal facial pain: Trigeminal facial pain can have many other causes that provoke pain, such as tumor compression of the trigeminal nerve; destructive nerve procedures such as glycerol rhizotomy; stroke; multiple sclerosis; dental procedures; facial trauma; or radiation side effects.
How are Cranial Base Disorders Treated?
Trigeminal neuralgia or atypical facial pain, hemifacial spasm, and glossopharyngeal neuralgia can have many causes, so treatment options vary based on a precise diagnosis and medical workup. Medication management (prescription medication, Botox, observation) and microvascular decompression surgery are procedures our practice recommends, depending on your symptoms and diagnosis.
Some other facilities offer gamma knife radiation or destructive nerve procedures, such as ablation or rhizotomy. We are happy to discuss all of these treatment options with you so you can make an informed decision.
What are the Symptoms of Skull Base Tumors?
The symptoms of skull base tumors vary based on where the tumor is located and whether it’s interfering with important structures. Common signs include:
- Trouble breathing or swallowing
- Unexplained changes in smell, taste, hearing, or vision
- Memory loss
- Ringing in the ears
- Facial pain or numbness
How Are Skull Base Tumors Diagnosed?
If you have been experiencing continual symptoms and are concerned about a skull base tumor, please make an appointment at Raleigh Neurosurgical Clinic. Our doctors begin their thorough evaluation by taking a full medical history and conducting a neurological exam to assess vision, balance, and other functions.
To confirm a diagnosis, we will order additional tests such as a computed tomography (CAT) scan, MRI, positron emission tomography (PET), an angiogram (an X-ray that helps us visualize the blood vessels), as well as hearing, visual or endocrine bloodwork examinations.
We may decide to perform a biopsy, which involves taking a small sample of tissue to test it for cancer. We might be able to do this during a nasal endoscopy, a procedure in which the doctor uses a thin, flexible tube with a camera and a light to examine the nasal and sinus passages.
How Are Skull Base Tumors Treated?
Skull base tumor treatment depends on several factors, including the size, location, and type of tumor. We also consider the patient’s health and personal preferences.
We may recommend surgery to remove the tumor, or we may decide that a combination of chemotherapy and radiation is the best route. Sometimes, if the tumor is small and not causing symptoms, we will observe it over time (“watchful waiting”) to see if we need to take action.
At Raleigh Neurosurgical Clinic, we offer the following surgical procedures for skull base tumors:
- Craniotomy: The removal of a brain tumor through an opening in the skull.
- Transnasal transsphenoidal surgery: A minimally invasive procedure performed through the nostril and nasal cavity with super-micro instruments under microscope guidance.
- Endoscopic surgery: A minimally invasive procedure that uses instruments inserted through a small tube that passes through the nasal cavity to remove the tumor.
- Stereotactic biopsy: A targeted biopsy to determine and remove suspicious tissue.
- Ventriculoperitoneal shunting: Used to treat the buildup of cerebral spinal fluid, or hydrocephalus, which can be caused from a bleed in the brain due to injury or illness or surgical complication, or present as a symptom of a brain tumor.
If you need stereotactic radiosurgery (gamma knife, cyber knife, proton beam, LINAC), which is radiation therapy used to treat malignant tumors or sometimes residual brain tumor cells, we will refer you to radiation oncology at an outpatient facility.
Our providers have deep expertise in the care of skull base tumors. World-renowned neurosurgeon Dr. Takanori Fukushima developed an innovative technique called “keyhole surgery” that minimizes the size of the craniotomy and reduces risk and recovery time. Dr. Fukushima has educated and trained our providers on this minimally invasive technique.
Your care team may include specialists who have advanced training in treating skull base tumors, such as skull base surgeons, radiation oncologists who have expertise in administering radiation, and plastic surgeons who specialize in restoring appearance of the head and neck.
Guiding You Through Your Healthcare Journey
Getting the treatment you need for a skull base tumor can be complicated. Our nurse navigators are here to make it easier. Your nurse navigator can help you with various aspects of your care, including scheduling appointments, getting connected with helpful resources, interpreting unclear medical language, and offering emotional support.
Learn more about nurse navigators at Raleigh Neurosurgical Clinic.
Make an Appointment
At Raleigh Neurosurgical Clinic, our skilled neurosurgeons have extensive experience treating skull base tumors. To meet with one of our skull base tumor specialists, make an appointment today or contact our nurse navigators.