Head and neck tumors touching or even extending through the skull base require intervention by a multidisciplinary team of skull base surgeons, head and neck surgeons, neuroradiologists, and oncologists. Many tumors previously considered inoperable can now be treated using endoscopic and microsurgical techniques, which markedly reduce mortality and morbidity rates. Tumors forming in the orbit, paranasal sinuses, and base of the skull on which the brain sits, rest in sensitive areas that demand expertise and skill to avoid serious damage and disfiguring scars.
Generally, surgery poses the greatest benefits for patients with skull base tumors, especially for benign lesions. Often, physicians treat malignant tumors with a combination of surgery, radiotherapy, and chemotherapy. Radiation, including radiosurgery or brachytherapy, helps preserve a patient’s basic mental and motor functions over longer intervals than does standard radiotherapy. Physicians generally reserve chemotherapy for patients with inoperable tumors. Many postoperative patients require a period of rehabilitation therapy due to the sensitive nature of these tumors.
Serious skull base cancers often necessitate surgical removal, but the presence of critical neurovascular structures often limits surgical options. Specialized surgeons must identify and preserve these vital structures and often embrace multiple surgical approaches, such as transcranial-subtemporal, transochlear, anterior transpetrosal, tranmaxillary, and postauricular incisions. Should surgery prove initially impossible, a combination of radiation and chemotherapy may allow a surgeon to intervene at a later time.
Due to the complex relationships of these tumors to important brain and vascular structures, surgeons experienced in skull base approaches and techniques invariably have the best reported results.