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Skull Base Surgery - Overview

Skull base surgery is usually an endoscopic skull base surgery rather than an open surgery that is done at the base of the skull and at the top of the first few vertebrae on the spinal cord. It is a procedure done to eliminate cancerous or benign growth and brain abnormalities present in the underside of the brain. Based on the symptoms, the type of growth and its location, your surgeon will advise the best type of surgery.

Skull Base Surgery - Symptoms

A neurosurgeon will recommend a skull base surgery procedure for the patients suffering from the following medical disease:

Arteriovenous malformations – the arteries and veins create an abnormal connection that tends to circumvent the capillary system
Cerebral aneurysm
If there is a Cysts in the brain from the time of birth
An unexpected growth occurring as a result of some infection
Chordomas – It is a kind of bone cancer in a malignant form
Pituitary Tumors
Craniopharyngiomas
A birth defect or disease in the skull known as Craniosynostosis
Trigeminal Neuralgia – It is a condition in the trigeminal nerve that causes chronic pain to the patient
cerebral spinal fluid leakage through the skull bone

Patients with some kind of abnormality in the base of the skull may also experience the following symptoms:

Numbness if you are experiencing any of the above problems, it is best to consult a neurosurgeon at the earliest.
Dizziness and visual problems
Severe headache
Hearing loss or constant ringing in the ears
Facial pain and weakness of the face
Nasal congestion and constant sinus infections

Skull Base Surgery - Pre-Procedure

As the skull base cannot be scanned with the naked eye; your doctor will recommend several medical tests and exams in the prognosis of cranial base surgery. Normally, your doctor will recommend you the following tests before planning your surgery:

A series of brain imaging tests that will include CT scans, MRIs, PETs, MRAs to clearly see the inside of the skull and identify the need for invasive or minimally invasive spine surgery.
A biopsy is performed to check for any cancerous growth in the area.
The team of doctor will also conduct a physical exam to test the patient’s balance, cranial nerves for any hampered reactions, dips in muscle activity and a test for blurred vision and hearing ability.

Skull Base Surgery - During Procedure

As skull base surgery is an extensive surgery, the patient is given general anesthesia for about 24 hours. For additional comfort, the patient is also kept on a heating blanket that is positioned over an alternating pressure air mattress. When the main blood vessel, the petrous carotid is dissected, the patient’s blood pressure is purposely kept abnormally low. In the past, many patients experienced bleeding during surgery and thus, doctors today start fresh frozen plasma and platelet infusions once the patient has gone through 4 units of blood. This has become a standard procedure in modern times and has proved to prevent the potentially fatal intracranial bleeding during and post the surgery.

For an endoscopic surgery, the neurosurgeon makes a small cut in the nose through which the extra growth removal is possible. An endoscope, a thin tube with a light in the front is used to guide the surgeon towards the growth.
Before completing the surgery, the teams uses MRI scans to make sure that all the growth has been properly removed.
In the case of an open surgery, the doctor will make a large incision behind the hairline. In order to clearly reach the growth and eliminate it properly, the surgeon will have to remove parts of the bone from the bottom of the skull.
These are then reattached post the removal of abnormal growth from the skull base. Apart from endoscopic and open surgical procedures, many doctors will also recommend chemotherapy and radiation to patients with cancerous growths in their craniums.

Skull Base Surgery - Post-Procedure

After a skull cancer spine surgery, the patient is moved to the ICU and continuously monitored by their doctor and nurses. At this stage, the patient’s respiratory parameters need to be adequate and the patient should be able to maintain his blood oxygen saturation while being incubated and spontaneously breathing. Normally, patients can go home after 7 to 10 days, once all their reports are fine. However, complete recovery after this kind of surgery might take a few months and therefore, patients must take good care of them and avoid heavy activities.

Skull Base Surgery - Risk & Complications

Whether it is an open skull surgery or an endoscopic procedure, skull base surgery is a highly complicated procedure and thus, brings a large amount of risks and complications for the patient. Your doctor will explain all the possible risks of the surgery beforehand so that you can take a well-informed decision. Some common known risks include:

In rare cases, stroke and sudden death
Seizures
Rupturing of the carotid arteries
Loss of vision
Cerebrospinal fluid leakage
Trouble in swallowing
Unusual alterations in voice or hoarseness
Bleeding inside the skull
Cranial nerve loss, also known as nerve loss in the skull
Inability of blood to clot, medically known as Coagulopathy
Hypopituitarism, reduction in the secretion of hormones in the pituitary gland
Pneumothorax – a medical condition in which air of gas gets accumulated in the cavity between the lungs and chest

Skull Base Surgery - Doctors

Dr. Sandeep Vaishya

Director , MBBS, MS, MCh, Fellowship

Neuro and Brain

20 Years of Experience
Dr. Arun Saroha

Head of Department , MBBS, MS, MCh

Neurosurgeon

19 years of experience
Dr. Rohan Sinha

Senior Consultant, MBBS, MS, MCh

Neurosurgeon

16 years of experience