Diagnosis and Treatment

Patients at MD Anderson with tumors of the skull base receive complete diagnostic evaluation, treatment and follow-up care with the latest techniques and equipment. To address Ehab Y. Hanna, M.D., and Michael E. Kupferman, M.D., perform endoscopic surgery. Because of the unique characteristics of each tumor type and each patient, experts on the skull base team carefully tailor the diagnostic methods used and treatment regimens in each case to provide the best care for their patients. Treatment may involve surgery, radiation therapy, chemotherapy or a combination of therapies. Surgery for skull base tumors may involve either open or minimally invasive techniques. At MD Anderson, a team of neurosurgeons and head and neck surgeons work in concert to determine the best treatment strategy for each patient.

Open Surgical Approaches

Access to the complex anatomy of the skull base, which is positioned deep within the head, often involves intracranial and extracranial exposure through an open surgical approach. These open procedures commonly involve cranial and facial incisions as well as removal of some bone to provide access to the target area. The open surgical approach is the recommended approach for some patients, depending in part on the type of tumor and its anatomic location. After the tumor is removed, plastic and reconstructive surgeons precisely reconstruct the soft tissues and bone to provide the best possible functional and aesthetic outcome.

Minimally Invasive Surgery

Minimally invasive surgical techniques are performed with use of endoscopy, image-guidance and real-time MRI. These techniques allow access to tumors of the skull base, with minimal or no external incisions. Access is provided by use of endoscopes, and visualization of the target area is enhanced through image-guidance and real-time magnetic resonance imaging (MRI).

Endoscopy: allows surgeons to access the tumor by use of endoscopes, which are introduced through tiny holes in the skull (neuroendoscopy) or through the nose and sinuses (sinonasal endoscopy). The endoscopes have superb optical qualities that provide accurate visualization and precise access to tumors in various regions of the skull base. Endoscopy reduces the extent of surgery as well as the patient's hospital stay, complications and recovery time.

Image-guided surgery: performed with the use of preoperative images of the patient's tumor to guide surgeons during the operation. With this technique, preoperative computed tomography (CT) scans or magnetic resonance (MR) images are used during surgery to help guide the surgeon, acting as a type of navigation tool and confirming the patient's anatomy and the precise location of the tumor. Intraoperative image guidance enhances the accuracy and precision of minimally invasive surgery of the skull base.

Real-time MRI: provides surgeons with precise, "live" images of the patient's tumor and surrounding anatomy during surgery, increasing surgical accuracy and enhancing complete removal of the tumor. Real-time MRI helps surgeons to precisely evaluate the completeness of tumor removal during minimally invasive techniques.