Skull Base and Cerebrovascular Surgery
Skull base surgery is a subspecialty of neurological surgery focusing on the bony area below the brain, referred to as the skull base. Simply put, it is the base of the skull considered to start at the level of the eyebrow in the front and then extend down ending at the back where the neck meets the skull. This area houses crucial structures such as the brain stem, cranial nerves and also blood vessels; and contains various openings to allow these structures to pass through.
Given the confines and the delicate anatomy of the skull base, access to this area requires highly specialized surgical approaches performed by skull base surgeons for various noncancerous and cancerous growths and other benign conditions. Skull base surgeons utilize Endoscopic (minimally invasive/keyhole) or Open (craniotomy) procedures. In endoscopic skull base procedures, the camera at the end of a long endoscope is inserted through natural openings like the nose or mouth, or through a small incision just above the eyebrow. In other cases, open procedures may be necessary. Endoscopic and Open Surgery can sometimes be combined in the same setting to achieve the best outcome.
Cerebrovascular surgery is another subspecialty of neurosurgery which involves surgical procedures on the blood vessels that supply blood to the brain. Many blood vessels are located at the skull base and therefore access to these vessels requires the expertise of a skull base surgeon.
Skull base and Cerebrovascular surgery may be a treatment option for various diseases and conditions that include:
- Skull Base Tumors and Cysts
- Pituitary Tumors, Parasellar/Cavernous Sinus Lesions
- Acoustic Neuroma (or Vestibular Schwannoma)
- Clival Tumors
- Trigeminal Neuralgia, Geniculate Neuralgia, Glossopharyngeal Neuralgia
- Hemifacial Spasm
- Cerebral Aneurysm
- Arteriovenous Malformations (AVM) and Dural Arteriovenous Fistula (dAVF)
- Cavernous Malformations
- Cerebral Bypass Procedures (for strokes from Moyamoya and atherosclerosis conditions)
- CSF Leak
The symptoms that appear can vary depending on the type of condition and the location within the skull base. Some of the symptoms that may appear include:
- Pain in the face or spasms
- Problems with balance and coordination
- Facial weakness
- Visual problems
- Hearing loss or ringing in the ears
- Sensory or motor weakness
- Leakage of spinal fluid from the nose/ears