Skull Base Tumours

Overview

The skull base is located behind the face; it’s chiefly the area behind the eyes and nose, and then slopes down to the back of the head.

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About Skull Base Tumours

This delicate position in the body (close to the brain, spinal cord and eyes) makes these tumours particularly challenging to treat.

Almost all skull base tumour patients will experience significant symptoms such as headaches, pain/numbness in the face, memory problems, dizziness, nausea/vomiting, changes to vision, sinus issues and/or loss of balance.

Malignant (Cancerous)

These are invasive, can metastasise and require oncologic management.

Chordoma – malignant, slow-growing but locally destructive (located (clival, craniovertebral junction)
Chondrosarcoma – malignant cartilage tumour
Olfactory neuroblastoma – malignant neuroectodermal tumour (also called esthesioneuroblastoma)

Benign (non-cancerous) Skull Base Tumours

These are slow-growing, non-invasive, and don’t metastasise, but they can still cause serious symptoms due to their location:

Epidermoid cyst – or epidermoid cyst of the cerebellopontine angle (CPA) is a benign, congenital lesion that arises quite randomly. It happens when cells trapped get trapped in the neural tube closure (part of the brain and spine) during the person’s development in the womb
Pituitary tumours – typically benign adenomas
Meningioma – almost always benign (can be malignant in rare cases) and can be located throughout the skull base region (anterior, middle, posterior fossa; cavernous sinus; CPA)
Craniopharyngioma – benign but locally aggressive
Osteoma (skull base) – benign bony growth
Inflammatory pseudotumor – benign, inflammatory mass

Variable

These locations or categories can host either benign or malignant tumours, it depends on the individual’s specific pathology

Tumours of the anterior cranial fossa – may be meningioma (benign) or sinonasal carcinoma (malignant)
Clival tumours – often chordoma or chondrosarcoma (malignant), but can include benign lesions
Jugular foramen tumours – may be paraganglioma (usually benign), schwannoma or carcinoma (cancerous)
Parapharyngeal space tumours – can be salivary gland tumours (benign or malignant), sarcomas or neurogenic tumours
Infratemporal fossa tumours – often malignant (e.g. sarcomas, carcinomas), but may include benign neurogenic tumours
Cavernous sinus tumours (CN III–VI involvement) – may be meningioma, schwannoma or metastatic lesions
Orbit (apex, optic canal) – can be benign (e.g. optic nerve sheath meningioma) or malignant (e.g. rhabdomyosarcoma, metastases)

Skull Based Tumour Treatments

Skull Base Tumours are typically treated with a combination of surgery and cancer treatment for malignant tumours. For surgery this can either be key-hole techniques or endoscopic endonasal surgery (EES). Sometimes an open approach (the surgeon may access via the side of the face, by the ear, the scalp or the nose depending on where the tumour is located). Read more about Skull Base Specialists’ pioneering surgical and endoscopic procedures for skull base tumour treatment here.

After treatment, MDT specialists are organised to reconstruct the integrity of the skull base and the function of the major organs (as well as facial plastics for aesthetics and appearance).