Skull Base Procedures
Comprehensive treatments for tumors of the skull base
Tumors of the skull base occur in areas near the nose, sinus, eyes, ear and brainstem. Due to the location, skull base tumors can affect the delicate nerves and blood vessels near and around the brain.
The comprehensive skull base team of experts at IU Health evaluate and treat patients with benign (noncancerous) and malignant (cancerous) tumors of the skull base.
Our Approach
At IU Health, we use a team approach to diagnose, treat and manage skull base tumors. This ensures all professionals involved in your care understand your needs and your treatment plan.
Our team includes:
- Neurotologists
- Neurosurgeons
- Head and Neck Surgeons
- Radiation oncologists
- Oncologists
We make sure you receive the most innovative, comprehensive treatment from the nation's most experienced tumor specialists. We also give you a customized treatment plan for your medical condition.
Our Approach
At IU Health, we use a team approach to diagnose, treat and manage skull base tumors. This ensures all professionals involved in your care understand your needs and your treatment plan.
Our team includes:
- Neurotologists
- Neurosurgeons
- Head and Neck Surgeons
- Radiation oncologists
- Oncologists
We make sure you receive the most innovative, comprehensive treatment from the nation's most experienced tumor specialists. We also give you a customized treatment plan for your medical condition.
Treatment
IU Health provides a variety of treatment options for skull based surgery and conditions.
Skull base tumor
Treatment of skull base tumors may include surgery, radiation therapy, reconstructive surgery, or a combination of these approaches. The doctors at IU Health provide an individualized treatment plan based upon the type of condition, symptoms, age, location and patient preferences.
Tumor types often include:
- Acoustic neuromas
- Meningiomas
- Pituitary adenomas
- Paragangliomas
Our skull base surgeons also treat non-tumor conditions, such as spontaneous cerebrospinal fluid (CSF) leaks.
Acoustic Neuroma (Vestibular Schwannoma)
An acoustic neuroma is a benign tumor that has the potential to affect your balance and hearing nerves. They often occur on one side of your brain, tend to be slow growing and do not metastasize to other portions of the body.
On average, over 4,000 acoustic neuroma tumors are diagnosed in the United States each year.
The most common symptoms include decreased hearing and ringing sound in the ear (called tinnitus). Other symptoms may include:
- Loss of balance
- Facial numbness or tingling
- In rare cases of very large tumors, confusion and headaches
Treatment options depend upon your age and tumor size. Some tumors can be observed over a span of time to determine the tumor growth pattern.
Hearing preservation surgery can lead to favorable long-term results if you have a smaller tumor. Large tumors that compress the brainstem are often surgically removed. Preserving the facial nerve function is a top priority during surgical removal of acoustic neuromas. Facial nerve function after surgery is good when the tumor is small.
As tumor growth increases and interferes with your quality of life, you can feel safe knowing your IU Health neurotologist and neurosurgeon will consider every option when choosing a surgical approach.
Large Acoustic Clinical Trial
Indiana University is part of a national clinical trial for large acoustic neuromas (those larger than 2.5 cm).
Treatment
IU Health provides a variety of treatment options for skull based surgery and conditions.
Skull base tumor
Treatment of skull base tumors may include surgery, radiation therapy, reconstructive surgery, or a combination of these approaches. The doctors at IU Health provide an individualized treatment plan based upon the type of condition, symptoms, age, location and patient preferences.
Tumor types often include:
- Acoustic neuromas
- Meningiomas
- Pituitary adenomas
- Paragangliomas
Our skull base surgeons also treat non-tumor conditions, such as spontaneous cerebrospinal fluid (CSF) leaks.
Acoustic Neuroma (Vestibular Schwannoma)
An acoustic neuroma is a benign tumor that has the potential to affect your balance and hearing nerves. They often occur on one side of your brain, tend to be slow growing and do not metastasize to other portions of the body.
On average, over 4,000 acoustic neuroma tumors are diagnosed in the United States each year.
The most common symptoms include decreased hearing and ringing sound in the ear (called tinnitus). Other symptoms may include:
- Loss of balance
- Facial numbness or tingling
- In rare cases of very large tumors, confusion and headaches
Treatment options depend upon your age and tumor size. Some tumors can be observed over a span of time to determine the tumor growth pattern.
Hearing preservation surgery can lead to favorable long-term results if you have a smaller tumor. Large tumors that compress the brainstem are often surgically removed. Preserving the facial nerve function is a top priority during surgical removal of acoustic neuromas. Facial nerve function after surgery is good when the tumor is small.
As tumor growth increases and interferes with your quality of life, you can feel safe knowing your IU Health neurotologist and neurosurgeon will consider every option when choosing a surgical approach.
Large Acoustic Clinical Trial
Indiana University is part of a national clinical trial for large acoustic neuromas (those larger than 2.5 cm).
Meningioma
A meningioma is a benign tumor that often originates from the coverings of the brain and spinal cord.
Meningioma tumors are typically slow growing, but can cause pressure on areas of the brain or brainstem. They can interfere with normal brain functions.
Meningiomas cause symptoms related to their location. Skull base meningiomas can cause hearing loss, swallowing difficulty or visual disturbances. Meningioma tumors are often twice as likely to occur in women as men.
Treatment depends on the location and size of the tumor in addition to your age and health. Observation, radiation therapy and surgery are all options at IU Health for treatment of meningioma tumors.
Pituitary Adenoma
A pituitary adenoma is a benign tumor often found behind the eyes and beneath the brain in the pituitary gland.
Pituitary adenoma tumors can affect how the pituitary gland secretes hormones that help regulate metabolism, tissue development, mood and sleep. Some tumors increase hormone secretion while others are ‘non-functional’ or non-secreting.
Symptoms can include:
- Infertility or low testosterone levels
- Diminished libido
- High blood sugars
- Gigantism from excessive secretion of growth hormone
When pituitary adenomas increase in size, they can compress the vision nerves leading to decreased peripheral vision. Other symptoms are often related to hormones secreted such as weight gain, loss of menstrual cycles in females, enlarged feet and hands.
Treatment options at IU Health include hormone testing and imaging studies to review the tumor size and distance from the pituitary gland.
Endoscopic pituitary surgery is a common option for treatment of pituitary adenoma tumors, while radiation therapy is an option for patients who may not be a candidate for surgery.
Spontaneous Cerebrospinal Fluid Leak (CSF Leak)
A spontaneous cerebrospinal fluid leak (or CSF leak) occurs when the fluid surrounding the brain leaks into the nose or ear through a hole in the dura or skull base bone. Spontaneous means the patient has not had an injury that could contribute to the leaking of CSF.
Symptoms often include copious drainage of clear fluid from the ear or nose. Often patients note there is a large wet spot on their pillow at night. You may have symptoms of meningitis (fever, nausea, headaches, lethargy) as the first sign of a CSF leak.
Treatment options at IU Health typically involves surgical repair of the CSF leak. Typically, endoscopic repair through the nose is performed for anterior skull base leaks and middle fossa craniotomy with repair of the skull base is performed for CSF leaks of the ear.
Neurofibromatosis Type 2
Neurofibromatosis type 2 (NF2) is a genetic disorder that affects the development of tissue in or around the nervous system. The most common tumors are vestibular schwannomas on both sides and meningiomas. Tumors along the spinal cord can also occur.
The most common symptoms include:
- Hearing loss
- Balance changes
- Dizziness or difficulties in walking
- Weakness
Other symptoms or signs include glaucoma and vision changes.
Treatment of NF2 patients requires a team of specialists with a patient-centered approach to your care. At IU Health, our specialist evaluates the hearing status, tumor size and location and tumor growth.
Surgery is a common option for treatment of tumors that are large and compressing the brain, while some patients can be treated with medications used to slow tumor growth over time. Clinical trials are ongoing to evaluate new medications in the treatment of these tumors.
Paraganglioma (Glomus Tumor)
Paragangliomas can occur in the skull base near the jugular vein in the upper part of the neck or they can be isolated to the middle ear. Typically, these tumors are vascular tumors, are slow growing, but are often locally aggressive.
Symptoms can include:
- Loss of function of lower cranial nerves that control gag sensation
- Voicing, swallowing and shoulder or tongue movement
Other symptoms include hearing loss or a pulsating sound in the ear that sounds like a heartbeat.
Treatment options include observation of tumors to determine if there is growth. If there is growth, radiation treatment, surgical treatment, or a combination are done to control the tumor and prevent future cranial nerve deficits.
