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Skull Base Surgery

Multidisciplinary surgical specialty addressing complex tumors and lesions at the cranial base through endoscopic endonasal, transcranial, and combined approaches with neuronavigation, intraoperative imaging, and skull base reconstruction techniques.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Skull Base Surgery?

Skull base surgery is a highly specialized multidisciplinary surgical field combining neurosurgery, otolaryngology (ENT), ophthalmology, plastic surgery, and head and neck oncology to address complex pathologies at the cranial base. This anatomically intricate region houses critical neurovascular structures including cranial nerves, internal carotid arteries, cavernous sinus, and brainstem proximity.

Approaches include endoscopic endonasal surgery (transsphenoidal for pituitary tumors, expanded endonasal for clival/anterior fossa tumors), transcranial routes (frontal, pterional, subtemporal, far-lateral), and combined techniques. Common pathologies treated include pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, sinonasal malignancies invading skull base, schwannomas, chordomas, and chondrosarcomas.

Modern skull base surgery utilizes intraoperative neuronavigation, high-definition endoscopy, intraoperative MRI/CT, neuromonitoring (cranial nerves, motor evoked potentials), and vascular Doppler. Reconstruction with vascularized nasoseptal flaps (Hadad-Bassagasteguy flap), pericranial flaps, and free tissue transfer prevents CSF leak and meningitis. Multidisciplinary tumor boards optimize patient selection and treatment planning.

Symptoms

Persistent headaches with neurological symptoms
Visual disturbances (bitemporal hemianopsia, visual loss, diplopia)
Cranial nerve deficits (facial numbness, hearing loss, swallowing problems)
Hormonal abnormalities suggesting pituitary involvement
Nasal obstruction with bloody discharge for sinonasal tumors
Anosmia (loss of smell) for anterior cranial base tumors
Pulsatile tinnitus or progressive hearing loss for petrous apex lesions

Risk Factors

Family history of neurofibromatosis type 2 (vestibular schwannomas, meningiomas)
Prior radiation therapy to head/neck (radiation-induced meningioma, sarcoma)
Genetic syndromes (Li-Fraumeni, Cowden, multiple endocrine neoplasia)
Chronic exposure to industrial chemicals or wood dust (sinonasal carcinoma)
Hormonal factors (meningiomas more common in women, hormone receptor positive)
Tobacco and alcohol use for sinonasal squamous cell carcinoma
Immunocompromised state (lymphoma, HIV-related malignancies)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent headaches with new neurological symptoms
  • Progressive visual loss or diplopia without explanation
  • Cranial nerve dysfunction (facial weakness, hearing loss, swallowing difficulty)
  • Hormonal abnormalities suggesting endocrine dysfunction
  • Nasal mass with epistaxis or persistent obstruction
  • Cerebrospinal fluid leak (clear watery nasal discharge)
  • Newly diagnosed skull base tumor for surgical evaluation

Treatment Methods

01
Comprehensive imaging including high-resolution CT (bone detail), MRI with contrast (soft tissue), MR angiography, and PET-CT for malignant tumors
02
Multidisciplinary tumor board evaluation including neurosurgery, ENT, neuroradiology, oncology, and pathology
03
Preoperative endocrine evaluation for pituitary lesions, neuro-ophthalmology assessment, and audiometry as indicated
04
Surgical approach selection based on tumor location: endoscopic endonasal for midline tumors, transcranial for lateral/superior extensions, combined for complex tumors
05
Intraoperative neuronavigation, neuromonitoring, vascular Doppler, and intraoperative imaging when available
06
Skull base reconstruction with vascularized flaps (nasoseptal, pericranial, temporoparietal fascia) for CSF leak prevention
07
Adjuvant therapy: stereotactic radiosurgery or fractionated radiation for residual tumor, chemotherapy for selected malignant pathologies, long-term surveillance imaging

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.