Skull Base Surgery

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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. Previously used traditional surgery methods for head and neck tumors resulted in large scars that surgeons were challenged to mask.

Los Angeles Neurosurgical Institute’s 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 removing benign and cancerous growths, and abnormalities on the underside of the brain, the skull base, or the top few vertebrae of the spinal column wherein instruments are inserted through the nose or mouth, or by making a small hole just above the eyebrow.

During skull base surgeries, a radiologist may be present to assist the surgeon via MRI to ensure complete growth removal.

Anatomy of the Skull Base & Surgical Approaches

The skull base is a complex irregular bone surface on which the brain rests. Contained within this region are major blood vessels that supply the brain with essential nutrients and important nerves with their exiting pathways. The floor of the skull is divided into three regions from front to back: the anterior, the middle, and the posterior compartments.

Anterior Skull Base Surgery

The anterior compartment is the region above a person’s eyes.

Diseases of the anterior fossa typically involve the paranasal sinuses, the orbit, and the nasal cavities. Anterior skull base lesions (also referred to as Midline or Paramedian) include olfactory groove and planum sphenoidale meningiomas, esthesioneuroblastomas and transcranial extensions of orbital and paranasal sinus tumors. Masses of the anterior fossa grow slowly; thus, they usually present when they have grown large already, resulting in considerable mass effect and symptoms.

LA Neurosurgical Institute’s endoscopic skull base surgery enables tumor resection through a small incision within the bridge of the nose or in the eyebrow, depending on the location of the tumor.

Middle Fossa Skull Base Surgery

The middle compartment is the region behind the eyes and centered on the pituitary gland, an organ required for proper hormonal function. Diseases of the middle fossa include pituitary tumors, craniopharyngioma’s, Rathke’s cysts, and chordomas.

Midline lesions are approached endoscopically through the right nostril and into the skull base. Cameras are used to provide the surgical team with incredible views of the brain.

Posterior Fossa Skull Base Surgery

The posterior compartment contains the brainstem and the cerebellum. The brainstem is the connection between the brain and spinal cord, where the nerves originate that control breathing, blood pressure, eye movements, swallowing, and other basic functions. Posterior skull base lesions such as acoustic neuromas or meningiomas of the cerebellopontine angle and neurovascular compression syndromes such as trigeminal neuralgia or hemifacial spasm. Symptoms of posterior fossa diseases include cranial nerve deficits, extremity weakness and gait problems.

Posterior skull base lesions are approached endoscopically through a dime size opening behind the ear on the corresponding side of the head where the lesion is present.

Tumors such as acoustic neuromas and meningiomas are resected using microsurgical techniques with custom microinstruments, bipolar electrogoagulation system and a microcaiton ultrasonic aspirator.

Neurovascular compression syndromes like trigeminal neuralgia and hemifacial spasm are similarly managed with custom designed microinstuments for the safe dissection of intracranial vessels from cranial nerves, followed by insertion of a teflon pledget between the vessel and the nerve.

Dr. Levesque - Our TeamExpert Surgical Skill

The surgical team at LA Neurosurgical Institute, led by Dr. Michel Levesque, has helped revolutionize the field of skull base surgery with improvements to anesthetic and surgical techniques.

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