MD Anderson is one of the few cancer centers in the United States with a comprehensive program focused on malignant and benign skull base tumors. This high level of experience and expertise could make a difference in the success of your treatment.
MD Anderson's team approach to skull base tumors brings together renowned experts from many specialties to give you comprehensive, personalized care. A group of specialists meets regularly to discuss your needs and options. This exchange of ideas sets the stage for delivering the highest level of care for skull base tumors.
This approach begins with your first visit and continues through diagnosis, treatment, rehabilitation and follow-up. Your team may include surgeons, radiation and medical oncologists, ophthalmologists, nutritionists, nurses and social workers. And they have at their fingertips the latest technology and techniques to diagnose and treat skull base tumors, including minimally invasive surgery, innovative radiotherapy and one of the few proton therapy centers in the nation.
Surgical Skill
Surgery is often part of the treatment for skull base tumors. The location deep in the structures of the head presents significant challenges because important nerve and brain structures may be involved.
Our surgeons have pioneered techniques and surgical approaches that allow for maximum safe removal of tumors in this delicate and complex area. They are experts in open and minimally invasive diagnostic and surgical approaches to skull base tumors.
Members of both MD Anderson's Head and Neck Center and Brain and Spine Center, our surgeons have extensive experience in skull base tumor procedures. They have been recognized in US News & World Report's list of Best Doctors in America, and they are respected around the world.
Advanced Radiation Therapy, Rehabilitation
For patients with skull base tumors that are responsive to irradiation, radiation oncologists prepare three-dimensional treatment plans for the precise delivery of radiation therapy. MD Anderson's Proton Therapy Center provides an additional treatment option for patients with specific tumors that are well suited to this innovative therapy.
Giving patients with skull base tumors the opportunity and the tools to enjoy life fully is an important part of care at MD Anderson. Many patients can overcome limitations caused by skull base tumors or treatment effects with the help of caring professionals, who may include audiologists, behavioral psychologists, language therapists, neuropsychologists, nutritionists and occupational, physical, speech and swallowing therapists.
And, as one of the nation's leading cancer centers, MD Anderson is able to offer a range of clinical trials of new treatments for skull base tumors.
Every time I see beauty through my eyes, I am reminded of my miracle and how fortunate I was to be treated at MD Anderson.
Skull Base Tumor Facts
The skull base is the area behind the eyes and nose that slopes down to the back of the head. It forms the floor, or base, of the skull. The spinal cord, multiple nerves and the major blood vessels of the brain, head and neck pass through openings in the skull base.
The term “skull base tumor” refers to the tumor’s location. The type of cancer cell can be one of several. Some are malignant (cancer), and some are benign (non-cancerous). Even benign tumors can cause problems because they are growing in a confined space.
Skull Base Tumor Types
Skull base tumors are grouped by location and the type of cells in the tumor. Where a skull base tumor begins can make a difference in the type of cancer cells. Location also can influence symptoms and treatment.
Skull base tumors may start from:
- Areas below the skull base, such as the nasal sinus or inner ear
- Brain tumors that grow down toward the skull base
- The bones of the skull base
Benign skull base tumor types include:
- Meningioma
- Pituitary adenoma
- Acoustic neuroma (also called vestibular schwannoma)
- Glomus tumors (also called paraganglioma, glomus tympanicum, glomus jugulare, carotid body tumor)
- Neuroma (trigeminal neuroma, vagal schwannoma)
Malignant skull base tumor types include:
- Carcinomas (squamous cell, basal cell, adenoid cystic, adenocarcinoma)
- Sarcomas (chondrosarcoma, rhabdomyosarcoma, osteosarcoma)
- Esthesioblastoma
- Carcinoid (neuroendocrine carcinoma)
- Mucosal melanoma
Skull Base Tumor Risk Factors
Anything that increases your chance of getting a skull base tumor is a risk factor. Since skull base tumors are rare, risk factors are hard to determine.
Sometimes, inherited genetic conditions are linked to skull base tumors. In these cases, our genetics experts are part of the patient’s care team. The types of tumors that may be caused by genetic conditions include:
Bilateral acoustic neuromas, as well as other brain and spine tumors, may be caused by the genetic disorder neurofibromatosis type 2.
Paragangliomas (also called glomus tumors or carotid body tumors) may be caused by a familial predisposition for other tumors.
Not everyone with risk factors gets skull base tumors. However, if you have risk factors, it’s a good idea to discuss them with your doctor.
Research shows that many cancers can be prevented.
Some cases of skull base tumors can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Did you know?
Skull Base Tumor Symptoms
Skull base tumors may not produce symptoms until they grow large. If they do have signs, they vary from person to person depending on where the tumor is and how fast it is growing.
Skull base tumor symptoms may include:
- Pain or numbness in the face
- Weakness in the face
- Headache
- Recurrent sinus problems
- Stopped-up nose
- Loss of sense of smell
- Vision loss
- Double vision
- Hearing loss
- Ringing in the ears (tinnitus)
- Dizziness or loss of balance
- Shortness of breath
- Hoarseness, losing your voice
- Difficulty swallowing and frequent choking
Having one or more of these symptoms does not mean you have a skull base tumor. But you should talk to your doctor if you have any of these signs. They may mean you have other health problems.
Research shows that many cancers can be prevented.
Some cases of skull base tumors can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Skull Base Tumor Diagnosis
MD Anderson’s Skull Base Tumor program has specialized, dedicated pathologists with extensive backgrounds in these complex tumors. This sets us apart from most other cancer centers. Our focus and expertise can make a difference in the success of your treatment. In addition, we have the most modern and accurate technology and equipment available to help pinpoint skull base tumors.
Early and accurate diagnosis of skull base tumors is important. This will help your doctors choose the best type of treatment for you.
Skull Base Tumor Diagnostic Tests
If you have symptoms that may signal a skull base tumor, your doctor will examine you and ask you questions about your health and symptoms. Our team of experts carefully chooses the tests that are best for each specific tumor.
One or more of the following tests may be used to find out if you have a skull base tumor and if it has spread.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Angiography
Biopsy: One of these biopsy methods may be used:
- Fine-needle aspiration (FNA)
- Endoscope inserted through the nose and sinuses
- Surgery
Functional testing to find out how certain parts of the head and neck are working. These tests are chosen based on your symptoms and where the skull base tumor is. They may include:
- Hearing test (audiogram, auditory brainstem response (ABR)
- Vestibular tests (videonystagmography, rotary chair testing)
- Vision testing
- Videostroboscopy of vocal fold function
- Swallowing testing (modified barium swallow)
Getting A Second Opinion at MD Anderson
A correct diagnosis is critical to choosing appropriate treatment. The pathologists at MD Anderson are highly specialized in diagnosing and staging every type of skull base tumor.
Pathologists often have to base diagnosis of skull base tumors on very small pieces of tissue from biopsies. Because skull base tumors are complex and of many different types, correctly identifying the type of tumor may be difficult for pathologists who may see them only once or twice in a lifetime.
We welcome the opportunity to provide second opinions for skull base tumors.
Some cases of skull base tumors can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Skull Base Tumor Treatment
Our Treatment Approach
The specialists at MD Anderson take a team approach to skull base tumors, bringing together extraordinary expertise from many areas. We personalize your treatment to deliver the most-advanced care with the least impact on your body.
Skull base tumor patients benefit from the most advanced technology and treatments, many available at only a few locations in the country. Your recommended therapy may include:
- Minimally invasive surgery
- Proton therapy
- Innovative radiotherapy delivery techniques
- Advanced reconstruction surgeries
And we’re constantly researching newer, safer, more-advanced treatments for skull base tumors. This means we are able to offer a range of clinical trials for new treatments.
Our Skull Base Tumor Treatments
If you are diagnosed with a skull base tumor, your doctor will discuss the best options to treat it. This depends on:
- The type of tumor
- The location of the tumor
- Possible side effects of treatment
- Your health
Most skull base tumors may require surgery. Some can be treated without surgery (for example with radiation or chemotherapy). Others do not need to be treated right away and can be watched closely over time.
Your treatment for a skull base tumor will be customized to your particular needs. It may include one or more of the following.
Surgery
Like all surgeries, skull base tumor surgery is most successful when it is done by a specialist with a great deal of experience in the procedure.
MD Anderson’s renowned skull base tumor surgeons work in multi-specialty teams. They perform a high number of skull base tumor surgeries each year, using the least-invasive, most-advanced techniques.
The main types of skull base tumor surgery are:
Open surgery: Incisions (cuts) are made in the skin or the membranes of the nose or throat to expose the bone of the skull base. The incision often can be hidden in the hair, skin creases, nose or mouth.
The affected bone is removed to expose the tumor and to identify the important nerves and blood vessels. After the tumor is removed, the membrane that protects the brain and the surrounding soft tissues is closed to seal off the skull base. Occasionally, when large skull base tumors are treated, plastic surgeons rebuild the soft tissues and bone to optimize function and appearance.
Minimally invasive endoscopic surgery: Using no incisions or a few small ones in the skull or back of sinuses, the surgeon uses an endoscope (link to definition) to biopsy or remove the skull base tumor. This approach may:
- Lessen damage to healthy tissue
- Lessen time in hospital and recovery time
- Reduce complications
Image-guided surgery: CT (computed tomography) or MRI (magnetic resonance imaging) scans are taken before surgery. They then are used in the operating room to help guide the surgeon to the precise location of the tumor. This enhances the accuracy and precision of minimally invasive surgery of the skull base.
Real-time MRI: Provides surgeons with precise, "live" images of the tumor and surrounding areas during surgery. This increases the surgeon’s accuracy and the chance for complete removal of the skull base tumor.
Radiation Therapy
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target skull base tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. MD Anderson provides the most advanced radiation treatments, including:
Intensity-modulated radiotherapy (IMRT) including:
- 3-D conformal radiation therapy, which uses sophisticated computerized controls to deliver radiation beams from different angles to fit the exact shape of the skull base tumor
- Dynamic multi-leaf collimator (DMLC) uses metal ‘leaves’ to shape the radiation beam that is delivered to the tumor. As the radiotherapy arm moves, the computer-controlled ‘leaves’ are repositioned so that radiation beams can target even irregularly shaped skull base tumors.
Radiosurgery, such as Gamma Knife, focuses one large dose of radiation to small tumors (less than 3 centimeters)
Proton therapy: The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means that this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly to the skull base tumor site, while decreasing the risk of damage to nearby healthy tissue. It is especially valuable for some cancers deep in the body (such as skull base tumors) because it is targeted to deposit energy only in the area of the tumor. For some patients, this therapy results in better cancer control with less impact on the body.
Chemotherapy
The choice of chemotherapy is based on the type of tumor cell that is found in the skull base tumor. MD Anderson offers the most up-to-date and advanced chemotherapy options.
Our Skull Base Tumor Clinical Trials
Because of its status as one of the world’s premier cancer centers, MD Anderson participates in several clinical trials (research studies) for skull base tumors.
Studies of treatments based on tumor cell type may include laboratory or imaging tests to see if the treatment is working. Other studies track the quality of life of patients and their families. This may help lessen the effect of the tumor and its treatment on patients’ physical, mental and social well-being.
In March 2014, I tried to connect a boat trailer to my minivan, ploughed head-first into the closed tailgate and really hurt my neck.
An X-ray showed I hadn’t broken my neck, but the doctors saw something near the back of my brain, at the base of my skull. A CT scan confirmed it was a tumor. The doctor was elated because he found it before I had any symptoms. I had mixed emotions, and it took a while to process the news.
After many tests and several weeks in the hospital, we knew I had a tumor in my skull, at the base of my brain on the right side. But even after two needle biopsies, the doctors couldn’t diagnose the type of tumor or decide how to treat it.
Within 14 months, I’d begun experiencing major symptoms -- constant pain in my neck and head, weak legs, and an inability to walk or rise from a chair without assistance. Even a gentle cough could cause me to pass out if I didn’t lie down immediately. One day, the symptoms didn’t go away after I coughed. I ended up having emergency surgery to install a ventriculoperitoneal shunt to relieve pressure from the cerebrospinal fluid buildup in my brain caused by the tumor.
Afterwards, I finally received a diagnosis: clear cell chondrosarcoma. The neurosurgeon stated that the best he could do was to surgically remove some of the tumor and move me to the palliative ward.
On the road to skull base tumor treatment at MD Anderson
A friend who happened to be a retired physician researched treatments and facilities for me. Within two weeks, we were driving from Canada to MD Anderson in Houston, Texas, to meet a highly skilled skull base neurosurgeon named Franco DeMonte, M.D.
But before we made it to Houston, things went horribly wrong. In Salina, Kansas, I started vomiting every 20 minutes, and my head felt like it would split open. It turns out my medications had caused bleeding in my brain.
When we finally arrived in Houston on Oct. 20, 2015, I was admitted to MD Anderson’s Emergency Center.
A new diagnosis and skull base surgery
After DeMonte reviewed my medical data and MD Anderson’s pathologists reviewed my biopsies, they gave me a new diagnosis: small cell osteosarcoma, bone cancer in the base of my skull.
We felt relieved when we heard those amazing words: “This looks curable.”
By early November, I’d recovered from the debilitating brain bleed, moved from the ICU to the neuro floor, and was ready for surgery. Five very talented MD Anderson surgeons and their respective medical teams spent 13.5 hours removing a very large tumor from the base of my skull and my cerebellum and brainstem.
They separated the tumor from several cranial nerves, around which it had grown without any negative impact on the nerves themselves. It was a very major and technically difficult operation, performed by dedicated physicians under very difficult circumstances. I will likely never realize the full severity and difficulty of the surgery. But I do know one thing: God was in control from the beginning, and oversaw every step that was taken.
Safely through the flames
In December 2015, after 46 days in the hospital at MD Anderson, we made the five-day, 2,500-mile drive back home to Canada. In January 2016, I began chemotherapy in Seattle, Washington – just 2.5 hours from home – overseen by an oncologist who had completed a fellowship at MD Anderson. The chemotherapy successfully shrank the small piece of tumor that remained in the petrous apex region of my skull base.
When I look back on my journey, I can’t help but feel gratitude for making it safely through the flames. I’m now back at work, and I just had my chemotherapy port removed. I have CT scans and MRIs every three months and return to MD Anderson periodically for follow-up care. Everything is clear, and all the news I get is good news!
Request an appointment at MD Anderson online or by calling 1-877-632-6789.