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 surgical techniques, including endoscopic endonasal surgery, keyhole craniotomies and endoscopic transorbital approaches
- Advanced open surgical techniques
- Radiation therapy treatments including proton therapy; stereotactic radiotherapy and radiosurgery; and innovative radiation therapy imaging and 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. They are able to select the surgical approach that is best tailored to each individual patient.
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 reconstruction.
Minimally invasive endoscopic surgery: Using no incisions or just a few small ones in the skull, back of the sinuses or the eyelid crease, the surgeon uses an endoscope to biopsy or remove the skull base tumor. By taking advantage of natural corridors such as the nasal cavity or along the orbit, these procedures 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.
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
The types of radiation used to treat skull base tumors include:
Stereotactic radiotherapy (SRT): Stereotactic radiotherapy is a non-invasive treatment that uses dozens of highly focused radiation beams to target large radiation doses precisely to the shape of the tumor. SRT utilizes high-resolution 3D imaging and a specialized coordinate system to provide accurate mapping of the tumor. This minimizes impact on the surrounding normal tissue. SRT treatment is usually performed in one to five sessions.
Fractionated stereotactic radiotherapy: Another type of stereotactic therapy, fractionated stereotactic radiotherapy is used when multiple treatments (usually three to five) are needed. It is also called or stereotactic body radiation therapy or stereotactic ablative body radiation. It is used when a tumor is too large for a single stereotactic treatment or is very close to a critical organ.
Stereotactic radiosurgery (SRS): Stereotactic radiosurgery is a type of SRT. It is a non-invasive treatment that uses dozens of tiny radiation beams to accurately target tumors with a single high dose of radiation. Despite its name, SRS is not a surgical procedure. It does not require an incision or anesthesia.
Stereotactic radiosurgery is effective for treating tumors in small areas in the head and neck that cannot be reached by surgery. It also can be used on patients who cannot tolerate surgery or have had previous radiation therapy to the brain.
Proton therapy: Proton therapy is similar to traditional photon-based radiation therapy, but it uses a different type of energy that may allow doctors to target tumors with much more accuracy. This limits damage to nearby healthy tissue and allows for the delivery of a more powerful dose of radiation.
Proton therapy can be particularly beneficial in treating children with cancer or tumors located near important organs.
Reirradiation: The goal of skull base reirradiation is to provide long-term cancer control while also preserving quality of life.
Repeat radiation in an area that has already received radiation is very challenging. It is necessary to deliver the radiation precisely and accurately to avoid unwanted reirradiation of normal tissue. It is very important that the radiation oncologist and team have experience with reirradiation of skull base tumors.
MD Anderson is a world leader in head and neck reirradiation. Each plan is personalized by experts specializing in head and neck reirradiation. Advanced radiation techniques such as IMRT/VMAT, 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 study performed at MD Anderson showed that stereotactic radiosurgery reduced facial pain caused by certain skull cancers tumors and lessened the need to use narcotic pain relievers.
Chemotherapy drugs kill cancer cells, control their growth, or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
The immune system defends the body from infection and disease. Cancer is a complex disease that can evade and outsmart the immune system. Immunotherapy improves the immune system’s ability to eliminate cancer.
Skull base tumors may be treated with immune checkpoint inhibitors, which are a type of immunotherapy. Immune checkpoint inhibitors keep the immune system turned on within the tumor.
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These cancer-promoting molecules are usually made by the same genes that cause the cancer. Targeted therapies are designed to interfere with, or target, these cancer-promoting molecules.
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.
MD Anderson patients have access to clinical trials offering promising new treatments that cannot be found anywhere else.
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