Introduction
The skull is made up of bones and cartilage that form the cranium and the face, which envelops the brain. When a person touches the top of the skull, they can feel the bones of the cranium. The five bones that form the base of the cranium also help in the formation of the eye socket, the nasal cavity roof, the bones around the inner ear, and some sinuses. The skull base is a crammed area with separate openings and is complicated to operate. The spinal cord, nerves, and many blood vessels pass via these openings. Skull base surgery can be done to clear both non-cancerous and cancerous growths and anomalies at the bottom of the brain, the skull base, or a few of the top vertebrae of the spinal cord.
In this procedure, the surgeon intersects the brain by inserting instruments via the natural openings present in the skull, the nose, or mouth or by creating a small hole just above the eyebrow. This type of surgery demands a team of specialists that generally includes neurosurgeons, ENT (ear, nose, and throat) surgeons, radiologists, and maxillofacial surgeons.
What Is Skull Base Surgery?
Skull base surgery is a type of surgery that focuses on treating conditions that are seen at the base of the skull. These are the areas like the underside of the brain and vital nerves and vessels that leave out of the brain to support senses such as hearing, smell, and sight. The skull base surgery is challenging because it reaches these areas without harming or cutting through the skull and retracting the brain. The goal is to contact and operate on these difficult areas with as slight an impact on the normal brain as possible. Skull base tumors are also called cranial base tumors. These are some of the most complex, difficult, demanding, and technically challenging tumors to treat. Because of the site of the disorders at the bottom of the brain, the bottom of the skull, and the top vertebrae of the spinal column, they need highly skilled neurosurgeons and advanced diagnostic technology.
Why Is Skull Base Surgery Needed For?
The following are some of the conditions that can be treated by skull base surgery:
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Cysts that are developed or present from birth.
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Growths because of certain infections.
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Meningiomas. They are non-cancerous tumors that evolve from the meninges. (meninges are the membranes that are called the lining of the brain or the vertebrae and enwrap the brain).
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Pituitary tumors.
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Chordomas. They are slow-growing tumors of bone most typically found at the base of the skull.
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Trigeminal neuralgia. It is an intense unilateral pain in the face.
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Craniopharyngiomas. They are the growths that arise near the pituitary gland.
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Craniosynostosis. It is a condition where the bones of the skull of an infant close earlier than they should be, causing problems with the growth of the brain and the formation of the skull.
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A cerebral aneurysm. This type of aneurysm is a feeble, often protruding area in a blood vessel of the brain.
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Cerebrospinal fluid fistulas. A fistula is an unnatural connection between two body parts, such as a blood vessel, an organ, and another structure.
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Arteriovenous malformations, where veins and arteries are abnormally connected to one another.
What Are the Types of Skull Base Surgery?
Skull base surgery can be divided into the following types:
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Minimally-Invasive or Endoscopic Skull Base Surgery: This type of surgery would not need an extensive incision. A surgeon makes a tiny opening inside the nose to let a neurosurgeon resect a growth via a thin, lighted tube called an endoscope. An MRI (magnetic resonance imaging) is a kind of picture taken of the skull base using a computer and magnets and is generally done by a radiologist while the surgeons are operating to assist them in making sure all of the growth has been cleared.
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Open Skull Base or Traditional Surgery: This type of surgery is invasive in nature and requires incisions in the skull and in the facial area. Parts of bone have to be removed so that the growth can be caught and removed. An operating room microscope is usually used for this kind of surgery.
How Are the Abnormalities Treated by Skull Base Surgery Diagnosed?
The diagnosis of growths or abnormalities that need a skull base surgery is based on the patient’s symptoms and a physical exam. Because this area is not directly visible, these exams and imaging studies are significant parts of the diagnosis:
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Brain Imaging Studies: Special tests, such as CT (computed tomography) scans, MRA (magnetic resonance angiogram), MRI (magnetic resonance imaging), and PET (positron emission tomography), scan and take pictures of the skull to enable the medical team to see an anomaly or growth.
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Biopsy: A tiny piece of growth in the skull base is taken out and looked at with the help of a microscope. A biopsy can be done using an endoscope placed via the nose and sinuses. Biopsies can also be done by excisional biopsy or fine needle aspiration.
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Miscellaneous: The patient’s balance, muscle activity, muscle activity, cranial nerves, vision, and hearing can all be checked. Studies or scans of other systems and areas of the body can also be checked.
How to Manage the Patient After the Skull Base Surgery?
After skull base surgery, the patient has to be closely cared for by the medical team. Their goal has to be to allow the patient to return to normal activities of daily living. Some people require continued therapy, including radiosurgery, proton beam therapy, and radiotherapy. Many patients may need repeated imaging to make sure that growth will not recur over time. This treatment team can also suggest mental health and support groups for the patient and their family. The mental health of the patient after such type of major surgery needs to be taken care of.
Conclusion
Complicated pathologies at the base of the skull usually need approaches that are customized, which are based on one of the two techniques mentioned. Extension of approaches can be done by associates from other faculties like ENT (ear, nose, and throat) or maxillofacial surgeon, which is generally suggested. The prognosis is good if taken care of and with proper management.
