What I Treat
Skull Base Surgery
Surgery at the base of the skull
The skull base is the bony floor separating the brain above from the eyes, sinuses, ears and upper neck below, and it is threaded through with nearly every major nerve and blood vessel that leaves the skull. Operating here means working within millimetres of structures responsible for vision, hearing, facial movement and sensation, swallowing, and the brain's blood supply, which is why skull base surgery is rarely, if ever, a one-surgeon undertaking.
The foundation
The anatomy
The skull base separates the brain from the face, sinuses, and neck. It is dense with critical anatomy — cranial nerves that control vision, hearing, balance, facial movement, and swallowing; the carotid and vertebral arteries; the brainstem, which governs consciousness, breathing, and heart rate.
Surgery here is among the most technically demanding in neurosurgery. The margin for error is measured in millimetres, and the surgeon must navigate through narrow corridors of bone while protecting structures that cannot be sacrificed. Modern approaches use endoscopic techniques through the nose (endonasal) and microscopic approaches behind or above the ear (retrosigmoid, translabyrinthine, orbitozygomatic).
Clinical picture
Symptoms
Symptoms present in combinations that point toward the site.
- Hearing loss, tinnitus, or balance disturbance
- Facial numbness or weakness
- Double vision or visual loss
- Difficulty swallowing or hoarse voice
- Nasal obstruction or recurrent sinus problems
- Persistent headache, often worse in the morning
Work-up
How it is diagnosed
MRI with contrast
The primary imaging tool for skull base lesions, showing soft tissue in exquisite detail. High-resolution thin-slice sequences through the skull base are essential.
CT scan
Shows bony anatomy in fine detail — critical for surgical planning. CT defines the osseous corridors the surgeon must navigate and the extent of any bone erosion or hyperostosis.
Biopsy
Obtained endoscopically through the nose or via a stereotactic frame, depending on lesion location. Angiography is sometimes needed for vascular lesions to map the blood supply before surgery.
Management
Treatment options
Treatment of skull base lesions is highly individualised. The decision depends on the pathology, its size and location, the patient's age and general health, the presence and severity of symptoms, and whether the lesion is growing on serial imaging.
Observation
Serial scans for small, asymptomatic lesions that are not growing. Many benign skull base tumours — particularly small meningiomas — remain stable for years and require no intervention beyond periodic surveillance.
Surgery
Endoscopic endonasal, retrosigmoid, translabyrinthine, or orbitozygomatic approaches — each selected for the specific lesion and its relationship to critical structures. The goal is maximal safe resection.
Radiosurgery
Precisely focused radiation delivered in a single session or a small number of fractions. Often used for small to medium-sized lesions, either as primary treatment or combined with surgery for residual tumour.
The surgical approach is planned patient by patient, with 3D reconstruction of the anatomy used to select the corridor that minimises brain retraction and maximises exposure of the lesion while protecting critical neurovascular structures.
Outcomes
What to expect
Recovery depends on the surgical approach and the condition being treated. Each route to the skull base has a different recovery profile, and your surgeon will discuss what is realistic for your specific operation.
Medical disclaimer: The information on this page is for general educational purposes only. It is not a substitute for individual medical advice, diagnosis, or treatment. Always consult your own doctor or specialist with any questions you may have regarding a medical condition.