Center for Cranial Base Surgery

The Center for Cranial Base Surgery at the New York Head and Neck Institute and Cushing Neuroscience Institute are both part of North Shore-LIJ Health System. The physicians and staff of the Center provide world-class diagnosis and treatment of patients with tumors and other problems involving the base of the skull.

The surgeons at the Center are nationally ranked experts in minimally invasive surgery of the cranial base. They work alongside specialists in imaging and diagnosis of skull base disorders, as well as specialists in the treatment and rehabilitation of voice and swallowing disorders (speech-language pathologists). This collaboration gives the Center a holistic and comprehensive treatment program that is virtually unequaled in the country.

Frequently Asked Questions

What is the cranial base?

The cranial or skull base, literally the bottom of the skull, supports the brain and its coverings (meninges). The spinal cord and all of the nerves, arteries and veins to and from the brain pass through the skull or cranial base. These structures pass through small holes, often next to each other, called foramina.

The cranial base is made up of the undersides of the skull bones, the sinuses between the eyes, the temporal bone (where the inner ear is located), the tops of the eye sockets (orbits) and a single bone at the very back of the skull (occiput), that contains a single large hole (foramen magnum) through which the spinal cord passes to the body. It is one of the most structurally complex and difficult areas to study or operate on in the human body.

A special group of 12 large, paired nerves (one for each side of the body) called cranial nerves all pass through the cranial base. These nerves are both named and numbered from front to back based on where they arise from the bottom of the brain. For example, the nerves for smell (olfactory nerve) is cranial nerve I. The nerves to the back of the eye for vision (optic nerve) is cranial nerve II, and so on. The cranial nerves control many important functions in the body, such as swallowing, speech, balance, hearing, sight, facial sensation and expression, to name only a few. When a tumor is in the area and puts pressure on one of these nerves, it stops functioning, resulting in impairment of the functions it controls.

What is cranial base surgery?

Cranial base surgery (or skull base surgery) is one of the most difficult, complex and time-consuming types of surgery performed today, and it represents one of the latest surgical frontiers. It is usually performed to treat diseases -- especially tumors -- that begin in the brain, its coverings (meninges), the nerves going through the cranial base, the back of the nose (nasopharynx), the sinuses (air-filled cavities in the facial bones between the eyes), the arteries and veins and tissues covering them, the inner ear and the orbit (eye sockets). It is also used in the removal of tumors of the pituitary gland at the base of the brain (the master gland). It may be done for either malignant (cancerous) or benign (non-cancerous) tumors.

Cranial base surgery may also be done to repair leaks of the fluid surrounding and cushioning the brain (cerebrospinal fluid or CSF) into the nose or ear through a tear in the coverings of the brain -- a condition known as CSF rhinorrhea (draining nose) or otorrhea (draining ear). Occasionally, cranial base surgery may be done to treat infection of the bones of the skull base (osteomyelitis) that has usually spread from one of the sinuses beneath the cranial base.

The Center for Cranial Base Surgery uses minimally invasive surgical techniques, which ensure that the patient experiences a faster and more comfortable recovery, as well as a lower risk of damage to surrounding normal structures and permanent problems with vital functions after surgery.

What is unique about your patient care?

The Institute offers many programs, services and capabilities that address our patients’ special needs:

  • Patients can consult with multiple physicians on treatment options, undergo tests and receive results—all during a single appointment, at one location. This saves time and speeds specialists’ access to patients’ medical records.
  • Patients have the option of consulting with the surgical team’s support specialists to gain a complete awareness of the surgical process. These specialists include neuro-anesthesiologists, radiation-oncologists, interventional neuroradiologists and neuro-oncologists, along with experts in swallowing disorders.
  • Our physicians and surgeons strive to establish a collaborative relationship with each patient’s referring physician, and with all the medical professionals intimately involved with the patient's care. This practice reinforces the continuity of care before and after surgery.
  • We understand that personal appearance can influence a patient’s recovery. For example, we don’t remove a surgical patient’s hair unless absolutely necessary. This small consideration can help facilitate recovery and strengthen patients’ self-esteem.
  • Patient Networking - Our patient networking program puts patients in touch with each other, especially new patients with former patients who have experienced a similar disease, condition or treatment.
What tumors and disorders do you treat?

The following is a list of some of the tumors and conditions treated at the Center.

Craniofacial/Sinus Tumors

  • Cancers of the sinuses and nasal cavity
  • Fibrosarcoma (a malignant tumor of the tendons or muscle linings at the cranial base)
  • Fibrous Dysplasia
  • Hemangiopericytoma (a malignant tumor of the cells surrounding small blood vessels)
  • Juvenile Angiofibroma
  • Liposarcoma (a malignant tumor of fat cells)
  • Nasopharyngeal carcinoma
  • Neurofibromas (benign tumors of the cells that insulate nerve fibers
  • Olfactory neuroblastomas (malignant tumors of the cells from the nerve at the top of nose and base of the brain that enable the sense of smell)
  • Orbit tumors (tumors of the structures in the eye socket both benign and malignant)
  • Osteomas (benign tumors of the bones of the skull base or face)
  • Paraganglioma
  • Rhabdosarcoma (a highly malignant tumor of muscle cells that usually occurs in children)
  • Salivary gland tumors (benign and malignant tumors of the salivary glands, the biggest being the parotid which swells up when you have mumps)
  • Sinonasal undifferentiated Carcinoma (SNUC)
  • Spindle cell sarcoma (a malignant tumor of fibrous tissue)

Non-tumor-related Disorders of the Cranial Base

  • Cerebrospinal fluid leaks (leakage of the fluid surrounding the brain through the tough coverings of the brain into the nose, ear or sinuses)
  • Cranial osteomyelitis (a chronic severe infection of the bones of the face or skull base, usually requiring bone removal and antibiotics by vein)
  • Craniofacial deformities, e.g. orbital (eye socket) defects
  • Cranial skeletal defects (abnormal shape of the bones making up the skull or face that are usually congenital -present at birth)
  • Facial nerve paralysis
  • Glossopharyngeal neuralgia (chronic severe pain in the tongue or throat)
  • Hemifacial spasm (a facial tic on one or both sides of the face)
  • Odontoid resection (a small spur like bone overgrowth at the second highest vertebrae in the neck that can cause problems by pressing on the spinal cord)
  • Trigeminal neuralgia

Neurosurgical Tumors

  • Acoustic neuromas
  • Astrocytomas (malignant tumors of the cells that support the nerve cells in the brain)
  • Chondrosarcomas
  • Chordomas
  • Ependymomas (benign tumor of the cells of one of the brain coverings and canals in the brain that secrete cerebrospinal fluid)
  • Gliomas (benign tumors of the cells that nourish and support the brain cells, neurons)
  • Glioblastoma (a malignant tumor variant of the glioma described above)

Learn more >>

The above is a very partial list of the large number of benign and malignant skull base tumors. It is suggested that patients with questions contact the Center for Cranial Base Surgery directly.

Do benign tumors cause health problems?

At the Center for Cranial Base Surgery, we treat both benign (non-cancerous) and malignant (cancerous) tumors arising from the brain or the structures entering and exiting the base of the skull. In addition, we treat non-tumor related disorders that, because of their location near the brain, may cause decreased function or death.

Many benign tumors can cause problems with functions such as swallowing, vision and balance because of their location at the skull base. As they grow, these tumors put pressure on surrounding structures in the compact area of the skull base and brain, so though benign, they may still be life-threatening.

What are the signs and symptoms of skull base tumors?

  • Headache
  • Loss or change of sense of smell
  • Change in vision
  • Double vision
  • Pain or numbness in the face
  • Weakness or asymmetric facial movement (difference between the two sides with smiling or frowning)
  • Nasal obstruction (plugged nose) and/or recurrent sinus problems or infections
  • Hearing loss
  • Ringing in the ears (tinnitus)
  • Dizziness or loss of balance (vertigo)
  • Shortness of breath
  • Hoarseness, losing your voice
  • Difficulty swallowing and frequent choking
  • Change in tongue movement

Learn more >>

How are patients with skull base tumors evaluated?

How are patients with Skull Base Tumors evaluated?The most advanced methods of diagnosis are available at the Center for Cranial Base Surgery:

  • MRI (magnetic resonance imaging)
  • CT Scan (computerized tomography)
  • PET /CT (positron emission tomography)
  • Cerebro vascular-evaluation and angiography
  • Audiogram
  • Neuro-ophthalmology and vision evaluation
  • Endocrinology evaluation
  • Minimally invasive directed biopsies
What are the treatments for cranial base tumors?

Many skull base disorders can now be treated with modern skull base surgery techniques with excellent results. Skull base disorders may be treated in one of the following ways:

  • Surgical removal using “open” approaches
  • Minimally invasive endoscopic surgery
  • Radiosurgery
  • Treatment for facial pain

Learn more >>

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Meet An Expert

Peter D. Costantino, MD, FACS

Peter D. Costantino, MD, FACS

Peter D. Costantino, MD, FACS serves as Exeutive Director of the NYHNI and as Director of Center for Cranial Base Surgery.

David Hiltzik, MD

David Hiltzik, MD

David Hiltzik, MD is a board-certified otolaryngologist with a subspecialization in cranial base and reconstructive surgery.

Dennis Kraus, MD

Dr. Dennis Kraus

Dr. Dennis Kraus's clinical practice focuses on the management of head and neck oncologic disease.

Steven D. Schaefer, MD, FACS

Steven D. Schaefer, MD, FACS

Steven D. Schaefer, MD, FACS, has special expertise in minimally invasive surgery of the sinuses, nose and anterior skull base.

David J. Langer, MD

David J. Langer, MD

David J. Langer, MD is a board-certified neurosurgeon with special interests in acoustic neuromas and cerebral aneurysms.

Mark Eisenberg, MD

Dr. Mark Eisenberg

Dr. Mark Eisenberg is Director of the Cushing Neuroscience Institute Skull Base Center as well as Chief of Neurosurgery and the site Director of the Neurosurgery Residency Program at Long Island Jewish Medical Center.

Dr. John Boockvar

Dr. John Boockvar is Director of the Center for Crainial Base Surgery as well as the director for the Center for Head & Neck Oncology. He is also the Director of the Brain Tumor Center at Lenox Hill Hospital.