Stanford Cranial Base Center
Skull base surgical techniques permit minimally invasive exposure of certain deep seated tumors located beneath the brain thereby facilitating optimal tumor removal while preserving function to the greatest extent possible.
The Cranial Base Center is a multidisciplinary program which combines the talents of surgeons from Otolaryngology (neurotology, head & neck oncology, sinus surgery) along with neurosurgery (neuro-oncology and vascular disorders) together with neural monitoring professionals and radiation oncologists to offer comprehensive management of these challenging tumors. The anatomical regions covered include the roof of the nose and paranasal sinuses, the nasopharynx, cavernous sinus, Meckel's cave, clivus, petrous bone, cerebellopontine angle, jugular foramen, foramen magnum, and the upper cervical spine.
Examples of tumors managed include meningioma, acoustic neuroma, other cranial nerve schwannomas, glomus jugulare, epidermoid, esthesioneuroblastoma, nasopharyngeal carcinoma, and pituitary adenoma.
Cranial Base Surgery
Until recently, many deep seated tumors located in the vicinity of the brainstem or beneath the cerebral cortex were either entirely inoperable, of could be exposed only through injurious degrees of brain retraction. Historically, all approaches to tumors inside the head began by temporarily removing a window in the plate like skull surface. For tumors located deeply within this often meant pulling or pushing important parts of the brain out of the way. This could result in brain injury affecting movement, feeling, speech, mental abilities, and other adverse neurological consequences. The basic concept that underlies cranial base surgery is removal of bone, often in a clever and anatomically complex manner, to reduce or even eliminate the need for brain retraction. Skull base procedures, for example, may be designed to traverse the bone containing the ear (petrous bone), around the eye (orbit), through the nose or paranasal sinuses, low on the temple beneath the brain, or even upwardly directly from the neck region. Fundamentally, these are minimally invasive techniques to afford the highest possible degree of tumor removal while preserving neurological function to the greatest extent possible.
When were Cranial Base techniques developed?
Cranial Base Surgery is a relatively recent innovation. High resolution imaging, such as CT and MRI provides the surgeon with anatomical detail essential to the rational planning of these procedures. If you cannot precisely map the tumors location and surrounding relationships to brain, nerves, and bony landmarks, you cannot design a rational approach for its removal.
Technologies used in Cranial Base surgery
Microsurgery of these tumors is technologically intensive endeavor. High power microscopes with fiberoptic illumination are essential as are high powered drills (with diamond burrs) to safely navigate cranial base bone crisscrossed by vital structures. These procedures involve operating in a virtual forest of important nerves which crisscross the operative field.
- Cranial Nerve Monitoring, in which a neurophysiologist tracks the various nerves' health on a computer system, greatly helping in optimizing neural preservation by identifying structures and facilitating gentle microdissection from tumor from nerve.
- Image Guidance is a high tech tool in which images of the tumor on CT and/or MRI are projected for the surgeon's use in the operating room. Using a "magic wand" whose position is localized in 3D space, the system can identify any position inside the patient's head in reference to the location of the tumor and surrounding vital structures.
Types of tumors approached with skull base techniques
A variety of different benign tumors such as meningioma, acoustic neuroma and other cranial nerve schwannoma, glomus jugularae, pituitary tumor, epidermoid, esthesioneuroblastoma, and many others are approaches with these methods. The anatomical regions covered include the roof of the nose and paranasal sinuses, cavernous sinus, Meckel's cave, clivus, petrous bone, cerebellopontine angle, jugular foramen, foramen magnum, and the upper cervical spine. Cancerous tumor, especially those that have eroded into the brain compartment from beneath, may also be approached using these methods. Skull base techniques are also sometimes employed to repair fractures of the skull base, for certain neurovascular disorders (e.g., aneurysms), as well as for certain deep seated infections of the skull base and the base of the brain.
Patient recovery following Skull Base surgery
Modern microsurgical skull base approaches have brought much improved results both in terms of tumor control, patient survival, as well as in numerous important quality-of-life measures.
Is surgery the only solution?
Not all skull base tumors require intervention. Some are so slow growing that they pose only minor risk of more serious problems, especially to older individuals. In such cases, the tumor may simply be monitored by periodic imaging studies. High technology radiation therapy is often an acceptable alternative and is at times preferable to microsurgery in selected cranial base tumors. The Cyberknife, which was developed at Stanford, is an extremely sophisticated tool for delivering focused radiation to skull base tumors while minimizing radiation exposure to sensitive surrounding structures. For more information: click here
Professionals involved in Patient Care
Management of tumors in and around the cranial base is a multidisciplinary endeavor involving neurosurgeons, neurotologists, head & neck surgeons, sinus surgeons, radiation oncologists, plastic surgeons, neuroradiologists, and neuropathologists, amongst others.
Stanford Skull Base Center Team
Department of Otolaryngology - Head & Neck Surgery: Neurotology
Department of Otolaryngology - Head & Neck Surgery: Head & Neck Surgery
Department of Otolaryngology - Head & Neck Surgery: Sinus Surgery
Department of Neurosurgery: Neuro-oncology
Department of Neurology: Neural Monitoring
Contacts for Stanford Cranial Base Center
New Patient Coordinator
For Medical InquiriesRobert K. Jackler, MD
Professor and Chairman
Department of Otolaryngology-Head & Neck Surgery
Stanford University School of Medicine
801 Welch Road
Stanford, CA 94305-5328
Main clinic line: (650) 723-5281
Fax (650) 725-8502