Skull base surgery: Maximizing your safety during brain surgery

When an aneurysm or tumor sits below the brain, skull base surgery can remove the lesion in a less invasive way than open brain surgery.

Your brain sits on the skull base or bottom part of the skull. This area includes your eye sockets, cheek bone, the top of your palate, your ear canals and the bottom part of your skull at the back of your head.

With skull base surgery, your neurosurgeon reaches the aneurysm or tumor from underneath the brain. Delicate surgical tools access the tumor through your nose and nasal passageways. This technique means you recover faster and have less risk for complications than with traditional open skull surgery.

We use the minimally invasive endoscopic endonasal approach for skull base surgery. This method avoids potential damage to your brain. Your neurosurgeon uses a long, thin, flexible telescope called an endoscope. They thread the endoscope through your nasal passageways to reach the tumor beneath your brain.

What conditions does this surgery treat?

We use skull base surgery to treat certain types of aneurysms and brain and pituitary tumors. 

We take MRI and CT scans to diagnose and locate your tumor. Your doctor decides if skull base surgery is right for you based on your tumor location.

We use skull base surgery to care for patients with:

• Acoustic neuroma 

• Aneurysms

• Arachnoid cysts

• Arteriovenous malformation

• Auditory rehabilitation

• Cavernous angiomas

• Chondrosarcoma

• Clivus chordoma

• Encephalocele (cerebral spinal fluid leak)

• Epidermoid (congenital cholesteatoma)

• Esthesioneuroblastoma

• Glomus jugulare tumors

• Facial nerve disorders

• Jugular foramen tumors

• Meniere's disease

• Meningioma

• Petrous apex tumors

• Skull base infections and osteomyelitis

• Temporal bone auditory canal carcinoma

• Tic douloureux (trigeminal neuralgia)

• Vascular decompression

Will skull base surgery work for you? 

Before surgery, a nurse practitioner, neurosurgeon and an otolaryngologist (if needed), evaluate your health and your tumor to ensure that the procedure is the best option for you.

You meet with your tumor team to discuss what happens during skull base surgery. You also talk about the risks and benefits of the procedure.

You might need additional testing, including:

• Cerebral angiogram: This test determines the relationship of the arteries to the tumor. Your doctor uses it when a tumor is close to blood vessels.

• Stealth MRI: Your neurosurgeon uses this type of navigational MRI in the operating room to plan for the surgery.

On the day of your surgery, you meet with your tumor team to answer your questions. You receive anesthesia to put you to sleep so you do not feel pain during the procedure.

Using the endoscopic endonasal approach, your surgeon:

• Carefully inserts an endoscope through your nose and nasal cavities

• Removes a small area at the base of your skull to access the tumor

• Uses tools attached to the endoscope to take out the tumor or lesion

• Closes the hole in the base of your skull

• Removes the endoscope

The endoscopic endonasal procedure can take two to six hours depending on your type of tumor and its location. After surgery, your doctor fills your nose with nasal packing.

You spend two or more days in the hospital before returning home.

Your recovery time can range from three to four days to several weeks, depending on the exact surgical approach and the tumor location.

We offer specialized skull base surgery at our neurosurgery clinics in Madison, Wis.