Until recently, the difficulty in reaching the cranial base made treatment of skull base disorders difficult. Treatment was focused more on easing symptoms (palliative treatment) than curing the patient. This was particularly true of malignant (cancerous) tumors. When surgery was performed, it was done through an "open” procedure, with a large facial and neck incision. Problems with this approach included cosmetic concerns, as well as speech and swallowing problems and the impairment of other vital functions.
The invention of the fiberoptic endoscope (a small telescope that may be passed through the nostrils or a small hidden incision) has changed the way surgeons perform this procedure. Now, minimally invasive surgical techniques are possible, and allow for a much less traumatic approach to the delicate skull base area. These techniques made the removal of tumors of the cranial base possible. They also resulted in minimal cosmetic issues and minimal damage to surrounding nerves and blood vessels, as well as a faster, better recovery for the patient.
When it comes to brain tumor removal, our world-class team at The Center for Cranial Base Surgery uses the most appropriate and advanced approaches. Our surgeons carefully work to remove the tumor and dissect it away from the surrounding structures, including important nerves and blood vessels. We pride ourselves on restoring function in our patients and preserving aesthetics. Advanced technology such as intra-operative MRI scanning can provide real-time images throughout the surgical treatment to help remove brain tumors safely and effectively.
Craniotomy -- “Open” Approach to Surgery
A craniotomy is a surgical procedure that makes an opening in the skull bone to provide access to the brain. There are several different kinds of craniotomies that can be done for brain tumor treatment.
Endoscopic Skull Base Surgery
Technical advances in endoscope (small telescope) design and capability, along with specialized computer surgical navigation equipment, have further heightened our ability to successfully remove tumors in deep-seated areas of the skull. These design enhancements permit access into hard-to-reach areas through the creation of small, precise openings, which can be made through small incisions in the scalp (endoscopic skull base surgery), or through the nostrils (endonasal skull base surgery). As a result of these innovations, patients experience shorter stays in the hospital and faster recovery.
Our surgeons are at the forefront in the development of both endoscopic and endonasal minimally invasive skull base surgery techniques.
Some skull base tumors are better treated with radiosurgery, which involves giving a single, high dose of radiation to a specific area. Radiosurgery for brain tumor treatment is done as an outpatient procedure. The type, size and location of the tumor, patient’s age and medical condition are all reviewed before deciding whether a patient may have radiosurgery instead of surgical removal.
Treatment for Trigeminal Neuralgia and Facial Pain
The first line of treatment for trigeminal neuralgia is medication. In many cases, this is very effective and would allow you to better control your facial pain for long periods of time. If you are having worse pain or the pain is lasting for longer periods of time even after your medicine is changed, surgery may be a more effective treatment. There are three surgical treatments for trigeminal neuralgia:
- Microvascular decompression is an inpatient procedure performed under general anesthesia. It requires that a small opening be made behind the ear, allowing the neurosurgeon to view the trigeminal nerve through a microscope. The neurosurgeon then moves the blood vessels that are compressing the nerve and places a soft cushion between the nerve and the vessels.
- Percutaneous stereotactic radiofrequency rhizotomy (PSR) is a minimally invasive outpatient procedure performed to relieve pain. PSR destroys the part of the nerve that is causing pain and also suppresses pain signals to your brain.
- Stereotactic radiosurgery treats trigeminal neuralgia with a precise delivery of a single, highly focused, high dose of radiation in a one-day session.
Your doctor will explain each treatment, and together you will decide which one will be the best and safest for you. All skull base surgery patients are treated in the Neurosurgical Intensive Care Unit at North Shore University Hospital after surgery.