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The treatment of tumors at the base of the skull, which include acoustic neuromas and meningiomas, requires special expertise and a collaborative effort. At the skull base are important structures, nerves, and blood vessels that are vital to our function and appearance. Lahey Clinic is one of only a handful of medical institutions in the United States to offer comprehensive diagnostic, surgical and medical care across the full spectrum of cranial base disorders.
Types of Tumors
Getting to the skull base surgically requires special exposure and closure techniques to prevent the leakage of cerebrospinal fluid. Tumors that demand this type of expertise include skull base meningiomas, glomus jugulare tumors, malignant nasopharyngeal tumors and acoustic neuromas.
Symptoms
Early symptoms of skull base tumors are very subtle, and they may progress without the patient's awareness. Depending on the tumor location, symptoms may include: hearing loss; ringing in the ear; facial pain; difficulty swallowing; loss of smell; visual loss; double vision; weakness or paralysis; seizures; and unsteadiness of gait. The diagnosis is made using a combination of state-of-the-art imaging techniques, including MRI scanning with gadolinium contrast, and other tests recommended by an otologist (such as hearing tests), and angiography.
Treatment
For patients with acoustic neuromas who are in good health but show evidence of an active tumor, state-of-the-art microsurgery is advisable. Frequently, hearing can be saved if the facial nerve is preserved in tumor removal. Hearing and facial nerve function are generally monitored interoperatively.
In certain circumstances, stereotactic radiosurgery is advisable. This treatment can slow the growth of a tumor, but it does not result in its complete removal. We prefer the use of radiosurgery in patients who are in poor health and who have progressive symptoms, particularly in the advanced age group. MRI scanning makes it possible to do serial evaluations of patients and determine whether surgery is necessary. Our team approach at Lahey Clinic allows us to provide optimal care for patients with acoustic neuromas.
Our team of skull base surgeons includes neurosurgeon Carlos A David, MD and otolaryngologist Peter Catalano, MD, FACS. Plastic surgeons are often involved in complicated closures.
Clinical Center for Cranial Base Surgery
Under the co-direction of Carlos A David, MD and Peter Catalano, MD, FACS, the Clinical Center for Cranial Base Surgery diagnoses, treats and rehabilitates patients with the comprehensive range of skull base disorders and lesions. The Center's multidisciplinary medical team includes well-known leaders in the fields of otolaryngology, neurosurgery, radiation and medical oncology, head and neck reconstructive surgery, interventional neuroradiology, vestibular and rehabilitation medicine.
For patients with acoustic neuromas who are in good health but show evidence of an active tumor, state-of-the-art microsurgery is advisable. Frequently, hearing can be saved if the facial nerve is preserved in tumor removal. Hearing and facial nerve function are generally monitored interoperatively.
