Skull Base Frequently Asked Questions
Find answers to frequently asked questions before your visit to UPMC's Center for Skull Base Surgery.
What is the skull base?
The skull base (or cranial base) is the part of the skull (cranium) that supports the brain and separates the brain from the rest of the head. Blood vessels to the brain and nerves from the brain (cranial nerves) run through holes in the skull base. Below the skull base are the nasal passages, sinus cavities, facial bones, and muscles associated with chewing.
Traditionally, neurosurgeons treated conditions that arose within the skull and otolaryngologists (ear, nose, and throat doctors or head and neck surgeons) treated conditions that arose in the head outside the skull. Tumors and other diseases that affected the skull base or deep facial tissues were difficult to reach and a collaboration of surgical specialties developed to deal with these problems. Head and neck surgeons and neurosurgeons work together as teams of skull base surgeons.
What is skull base surgery?
Skull base surgery is surgery performed by a team of skull base surgeons which may include head and neck surgeons, neurosurgeons, plastic surgeons, and ophthalmologists (eye surgeons). Skull base surgery can be divided into the surgical approach, resection (removal of tumor), and reconstruction. There are many ways to approach the skull base. In the past, the favored approach was to approach the skull base from above (transcranial approach) and from below (transfacial approach) at the same time.
The transcranial approach consists of a scalp incision followed by a craniotomy (removing part of the skull). The brain is then lifted up to reach the skull base. The bones of the facial skeleton can be removed temporarily to increase the exposure.
The transfacial approach consists of incisions on the face or inside the mouth that provide access to the sinus cavities and skull base from below. Working from both sides of the skull base, the surgeons can then remove tumors that are at the skull base. Surgery results in a defect of the skull base and dura (thick lining over the brain) that needs to be repaired to prevent leakage of spinal fluid and infection (meningitis).
Over the last decade, new surgical techniques have been pioneered at the UPMC that allow the majority of skull base surgeries to be performed through the nasal passages using an endoscope. An endoscope is a lighted instrument that provides visualization within a cavity. All three stages of surgery (approach, resection, and reconstruction) are performed through the nasal passages without the need for scalp or facial incisions. These types of surgeries are described as minimally invasive but often allow the surgeons to perform more complete surgeries.
Our surgeons are experienced in all types of skull base surgery and utilize a variety of surgical approaches and techniques to design the best operation for the diagnosis.
What is the experience of the UPMC Center for Skull Base Surgery?
The UPMC Center for Skull Base Surgery has been a leader in skull base surgery for over 20 years. Since 1997, the current surgical team has performed more than 800 endonasal skull base surgeries in adults and children for a variety of benign and malignant (cancerous) conditions. In collaboration with colleagues at Children’s Hospital of Pittsburgh of UPMC, our surgeons have performed EEA on more than 60 pediatric patients.
The UPMC Center for Skull Base Surgery is recognized nationally and internationally as one of the leading centers and receives consultations and patient referrals from all parts of North America as well as other continents. Surgeons from other institutions in the United Sates and other countries come to Pittsburgh to learn about the latest minimally invasive techniques.
What will happen before surgery?
If surgery is recommended, additional testing is often necessary. This may include visits with additional specialists, medical clearance from your primary physician or anesthesiologist, and medical tests. CT and MRI scans are often obtained before surgery for use of an image guidance system.
Some surgeries are intentionally scheduled on two separate days. The tumor exposure is performed in the first stage and then removed during the second stage several days later.
What can I expect following surgery?
For a routine surgery, the nasal passage is filled with compressible packing or a balloon catheter. This remains in place for up to one week, depending on the extent of the surgery. This is easily removed prior to discharge or in the office if already discharged. Plastic splints are also placed in the nasal passage and these are removed several weeks after surgery.
Once nasal packing is removed, patients are instructed to spray the nasal cavity with saline (salt water) several times per day. Patients are seen every few weeks initially for endoscopic examination of the nasal cavity and removal of nasal crusts. By three to four months, healing is usually complete and crusting diminishes. Additional follow up depends on the diagnosis, need for additional therapy, and symptoms.
Patients are instructed to avoid activities that increase pressure of spinal fluid inside the head (bending, lifting, straining, nose-blowing) for a month after surgery in order to minimize the risk of a spinal fluid leak. A spinal fluid leak is characterized by the drainage of clear fluid from the nose. If a spinal fluid leak is confirmed, this can be repaired using endoscopic surgical techniques in most cases.
Most patients will notice a decrease in smell and taste following surgery for several months due to decreased air flow through the nose. This will often recover as healing occurs.