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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.
Not all tumors in the skull base are malignant (cancer). Even benign (non-cancerous) tumors can cause symptoms or threaten the health and well-being of the patient.
Tumors of the skull base are categorized based on the unique characteristics and cell structure of each type. Tumor typing is determined during the patient's diagnostic workup. Radiologists and pathologists who have special expertise in tumors of the head and brain work closely with the head and neck surgeons and the neurosurgeons to determine tumor type.
The tumor type, together with the unique health profile and needs of each patient, helps the skull base team specifically tailor treatment for each patient.
The most common malignant skull base tumors include:
- Adenoid cystic carcinoma
- Esthesioneuroblastoma or olfactory neuroblastoma
- Nasopharyngeal carcinoma
- Non-Hodgkin’s lymphoma
- Squamous cell carcinoma
Other malignant skull base tumors:
- Endolymphatic sac tumor
- Mucoepidermoid carcinoma
- Myeloma/plasma cell tumors
- Neuroendocrine carcinoma
- Sarcomas. The more common sarcomas are as follows:
- Ewing's sarcoma
- Sinonasal undifferentiated carcinoma
The most common benign skull base tumors include:
- Acoustic neuroma (vestibular schwannoma)
- Meningioma (the most common skull base tumor)
- Pituitary tumors
Other benign skull base tumors:
- Cholesterol granuloma, epidermoid and dermoid cysts
- Fibro-osseous lesions. These include the following:
- Fibrous dysplasia
- Ossifying fibroma
- Inverting Papilloma
- Carotid body tumors
- Glomus jugulare
- Glomus tympanicum
- Glomus vagale
- Jugular foramen schwannoma
- Trigeminal schwannoma
Head and neck tumors may also extend to the skull base. Examples include:
- Salivary gland tumors. (The most common types of salivary gland cancers are mucoepidermoid carcinoma and adenoid cystic carcinoma.)
- Skin cancers such as squamous cell carcinoma, melanoma and basal cell carcinoma that can travel along nerves and spread to the brain and skull base
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.
Previous exposure to ionizing radiation and certain occupational exposures have been identified as risk factors for meningioma, some sarcomas and certain sinonasal malignancies. Exposure to wood dust, heavy metals and a history of working with leather are also risk factors for developing some sinus and nose cancers. Certain types of nasopharyngeal cancers are related to childhood exposure with the Epstein-Barr virus.
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.
Pituitary tumors may be associated with multiple endocrine neoplasia 1 (MEN1) or family isolated pituitary adenoma (FIPA) which may be familial and predispose to 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.
Skull base tumor symptoms may include:
- Facial pain or numbness
- Facial weakness or paralysis
- Recurrent sinus problems
- Stopped-up nose
- Loss of sense of smell
- Vision loss
- Double vision
- Hearing loss
- Ringing in the ears (tinnitus)
- Dizziness, vertigo or loss of balance
- Shortness of breath
- Hoarseness, losing your voice
- Difficulty swallowing and frequent choking
- Lumps on the neck
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.
Patients at MD Anderson with tumors of the skull base receive a complete diagnostic evaluation, treatment and follow-up care with the latest techniques and equipment.
Because of the unique characteristics of each tumor type and each patient, experts on the skull base team carefully tailor the diagnostic methods and treatment regimens in each case to provide the best care for each patient.
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. Radiologists and pathologists who have special expertise in tumors of the head, neck and brain work closely with your doctor to determine the tumor type based on your diagnostic test results.
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
Biopsy: One of these biopsy methods may be used:
- Fine-needle aspiration (FNA)
- Endoscope inserted through the nose and sinuses
- From the ear using a microscope
Functional testing to find out how certain parts of the brain, 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)
- Balance tests (videonystagmography, rotary chair testing)
- Vision testing
- Videostroboscopy of vocal cord function
- Swallowing testing (modified barium swallow)
- Neurocognitive evaluation to test for memory and cognition changes
- Hormone testing
- Smell testing
Our Treatment Approach
The specialists at MD Anderson take a team approach to skull base tumors, bringing together extraordinary expertise from neurosurgery, head and neck surgery, plastic surgery, medical, and radiation oncology, and many other 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
- Chemotherapy, targeted therapy, and immunotherapy
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 and extent of the tumor
- Possible side effects of treatment
- Your health
Most skull base tumors 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, under the care of an experienced skull base specialist.
Your treatment for a skull base tumor will be customized to your particular needs. It may include one or more of the following.
Like all surgeries, skull base tumor surgery is most successful when it is done by a surgeon with a great deal of experience in the procedure.
MD Anderson’s renowned skull base tumor surgeons work in multi-specialty teams. They perform hundreds of skull base tumor surgeries each year, using the most-advanced techniques.
The main types of skull base tumor surgery are:
Open surgery: Incisions are made in the skin or the membranes of the nose, mouth 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. When muscles and nerves are affected, highly specialized plastic surgeons may provide facial reanimation and complex craniofacial construction.
Minimally invasive endoscopic surgery: Using no incisions or a few small ones in the skull or back of the sinuses, the surgeon uses an endoscope 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, precision and safety of 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.
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 unparalleled clinical expertise with the most advanced radiation treatments, including:
Intensity-modulated radiotherapy (IMRT): IMRT uses sophisticated computerized controls and software to deliver radiation beams in different angles to fit the exact shape of the skull base tumor. IMRT technology lowers the radiation dose to the normal tissue surrounding the tumor and lessens the side effect of treatment.
Stereotactic radiosurgery is the focused delivery of large doses of radiation to tumors in one or a few sessions without the need of a scalpel or any incision. This method provides the ability to targets skull base tumors with very high accuracy and precision. One of several radiosurgery techniques available at MD Anderson for skull base tumor treatment include:
- Gamma Knife delivers highly focused beams of radiation to treat small skull base tumors (usually those that are less than 3 centimeters in size). This is possible through the use of a special head frame placed by the Neurosurgeon to provide a stereotactic guidance system to target the tumor with high accuracy and precision. This eliminates unintended radiation dose and harm to the surrounding healthy tissue. Gamma Knife treatments are typically done in one day and do not require an overnight stay in the hospital.
- Stereotactic Body Radiation Therapy (SBRT) can treat tumors that are larger than 3 cm or located close to a sensitive structure, using a frameless custom mask, cushion and mouthpiece instead of a head frame. SBRT treatment usually consists of 3 to 6 radiation sessions given every other day and shortens the overall length of treatment from seven weeks to two weeks. Our team of radiation oncologists with expertise in treating skull base tumors will evaluate each case to determine the best radiotherapy approach to use.
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 these patients, proton therapy can result in better cancer control with less impact on the body.
MD Anderson offers many new and advanced radiotherapy technologies to deliver precision radiation to your specific skull base cancer. Our expert radiation oncologists will evaluate each case to determine the best radiotherapy approach to use. Together, they work closely with our skull base surgeons, neurosurgeons, medical oncologists and other doctors specializing in skull base cancers to coordinate treatment tailored for you.
Repeat radiation to the same area that has already received radiation is very challenging. It is necessary to deliver the radiation precisely and accurately to avoid unwanted reirradiation to the normal tissue. Each reirradiation plan is approached with the utmost care and thought, and each treatment is personalized to your needs. The goal of skull base reirradiation is to provide long-term cancer control but also to preserve quality of life. It is very important that the radiation oncologist and team have experience with reirradiation andof skull base tumors.
MD Anderson is a world leader in head and neck reirradiation. Advanced radiation techniques such as IMRT, proton therapy and stereotactic radiosurgery can be used to reirradiate skull base tumors when surgery is not possible. We also offer clinical trials for patients with unresectable tumors of the skull base who are receiving repeat radiation.
Palliative reirradiation: Stereotactic reirradiation of the skull base can be used to provide symptom relief from facial pain caused by cancer. A recent study performed at MD Anderson showed that Gamma Knife stereotactic radiosurgery reduced facial pain caused by certain skull cancers tumors and lessened the need to use narcotic pain-relievers.
Chemotherapy uses powerful drugs to kill cancer cells that multiply quickly. It may involve a single drug or a combination of two or more drugs, and can be used in combination with other treatments. MD Anderson offers the most up-to-date and advanced chemotherapy options.
Immunotherapy uses the body’s immune system to recognize and eliminate cancer. There are several types of immunotherapies offered at MD Anderson, and a patient's overall health and type of cancer determines the therapies available to them.
Targeted therapy, also called precision medicine, stops or slows the growth or spread of cancer by targeting specific molecules and cancer-causing genes. These therapies are often given along with another treatment like chemotherapy or radiation.
Our Skull Base Tumor Clinical Trials
Because of its status as one of the world’s premier cancer centers, MD Anderson leads numerous innovative 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.
A correct diagnosis is critical to choosing appropriate treatment and the first treatment is most important. Allowing time for a second opinion at MD Anderson provides access to a team of experts that specialize in treating skull base tumors.
Skull base tumors are rare and the pathology diagnosis can be difficult to pinpoint. Getting the correct diagnosis can change the treatment prescribed and impact survival. For example, approximately 25% of sinus and nasal cancers have a major change in diagnosis after the pathology is reviewed at MD Anderson. Additionally, 60% of skull base tumors have changes in grade, subtype or stage after their pathology is reviewed. Getting to the correct diagnosis early is vital to getting the right treatment, so second opinions are important for rare tumors.
Our faculty have unparalleled experience in the management of these rare tumors. We routinely evaluate and manage diseases that most physicians and surgeons have never or rarely ever seen in their practices. This depth of experience is critical in order to individualize and optimize the management of skull base tumors.
Our team has dedicated their practices to the care and management of patients with tumors of the skull base. We welcome the opportunity to provide second opinions for skull base tumors.
Why choose MD Anderson for your skull base tumor treatment?
MD Anderson's team approach to skull base tumors brings together renowned experts from many specialties to give you comprehensive, personalized care. Our team is comprised of surgeons dedicated exclusively to skull base tumors and sub-specialized to different types of skull base tumors. Although skull base tumors are rare, we see dozens of patients and perform skull base surgery every day.
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.
Our 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.
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 nerves, blood vessels 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 Brain and Spine Center and Head and Neck 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
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.
Rehabilitation, Symptom Management, Side Effects and Quality of Life Issues
Giving patients with skull base tumors the opportunity and the tools to enjoy life fully is an important part of care at MD Anderson. Skull base tumor patients may experience symptoms of tumors and side effects from treatment, like changes in hearing, vision, balance, smell, speech or memory. We understand that quality of life is an important consideration during cancer treatment and recovery. Many patients can overcome limitations caused by skull base tumors or treatment effects with the help of caring professionals, who may include audiologists, speech and language and swallowing therapists, behavioral psychologists, neuropsychologists, ophthalmologists, nutritionists, and occupational and physical therapists.
Treatment for tumors of the skull base may involve surgery, radiation therapy, chemotherapy or a combination of therapies. Surgeons in the Skull Base Tumor Program use both open and minimally invasive diagnostic and surgical approaches, depending on each patient's unique characteristics. For patients with tumors that are responsive to irradiation, radiation oncologists plan three-dimensional treatment algorithms for the precise delivery of radiation therapy. And with MD Anderson's Proton Therapy Center, proton radiation therapy now provides an additional treatment option for patients with specific tumors that are well suited to this innovative, state-of-the-art therapy.
And, as one of the nation's leading cancer center, 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.