17 January, 2019
What are skull base tumors?
The skull base is the area in between the eyes and behind the nose all the way up to the brain and spinal cord. It one of the/ or the more complex are in the whole body beacuse multiple nerves and the major blood vessels of the brain, head and neck pass through it. The skull base tumors are rare, affecting less than 1 in 100 000 people per year. They are histologically a diverse group of tumors and potentially pose significant management problems due to their close proximity to the orbit and intracranial cavity.
What are some possible causes of skull base tumors?
Skull base tumors are grouped in benign and malignant tumors. Location of the tumor is very important, as symptomatology will depend on it. Usually tumors original raised from the nose will give nasal obstruction and nosebleed, and tumors coming from the brain or spinal cord will give neurologic symptomps.
Benign skull base tumor
- Inverted Papiloma
- Nasopharyngeal angiofibroma
- Pituitary adenoma
- Neuroma (trigeminal neuroma, vagal schwannoma)
- Acoustic neuroma (also called vestibular schwannoma)
- Glomus tumors (also called paraganglioma, glomus tympanicum, glomus jugulare, carotid body tumor)
Malignant skull base tumor
- Carcinomas (squamous cell, basal cell, adenoid cystic, adenocarcinoma)
- Mucosal melanoma
- Sarcomas (chondrosarcoma, rhabdomyosarcoma, osteosarcoma)
- Carcinoid (neuroendocrine carcinoma)
What are the symptoms of these tumors
Patients with sinonasal tumors often present with vague symptoms, including nasal obstruction, nasal congestion and discharge, frequent bloody noses, headache, and/or facial pain. Patients can also have facial swelling, vision changes, or neurologic deficits. Some patients are asymptomatic.
Patients with tumors originating from the brain or spinal cord usually present with headache, loss of sense of smell, vision loss or double vision, pain or numbness in the face. Rarely they present with weakness in the face, ringing in the ears (tinnitus), dizziness or loss of balance, shortness of breath, hoarseness (losing your voice) and difficulty swallowing or frequent choking.
Diagnosis of the skull base tumors
The diagnosis of the skull base tumors starts with an exhaustive history and physical examination. Imaging studies always include a CT scan (for bony structures) and MRI (for soft tissue and nerves) to stage the tumor locally and to check for the presence of metastases, or spread. Biopsy of the tumor is necessary to make a final diagnosis. This can often be done in the office with topical or local anesthetic.
Treatment of the skull base tumors
Surgical therapy is the main treatment for most skull base tumors, now a day endonasal endoscopic surgery has became the standard treatment for these tumors. Radiation may be used alone if the tumor cannot be removed surgically or in patients who cannot tolerate surgery. Combination therapy of surgery and radiotherapy with or without chemotherapy is given in specific situations.
The barnaclínic+ Skull Base Team (Dr. Cristobal Langdon, Dr. Isam Alobid and Dr. Joaquim Enseñat) are world know surgeons that have a wide experience treating all kind of skull base tumors endoscopically and with open approaches.