What skull base tumours are
Skull base tumours grow along the floor of the skull, behind the eyes and nose and around the ears. The most common are:
- Pituitary tumours (adenomas), which can press on the nerves for sight or change the body’s hormones
- Vestibular schwannomas (acoustic neuromas), on the nerve for hearing and balance
- Skull base meningiomas, from the lining of the brain
- Rarer tumours such as craniopharyngiomas, chordomas and epidermoids
Most are benign. The challenge is position: they sit against nerves and arteries that cannot be replaced.
Signs
- Loss of the outer part of vision in both eyes, or blurred vision that glasses do not fix
- Hearing loss or ringing in one ear, or unsteadiness
- Numbness or pain in the face, or weakness of the face
- Hormone changes: missed periods, breast milk without pregnancy, growth of the hands and feet, weight gain, tiredness
- Headaches, double vision, or difficulty swallowing
Diagnosis
An MRI with contrast, often with thin slices through the area of concern, shows the tumour and its relation to the nerves and arteries. A CT scan shows the bone. Pituitary tumours need a full hormone profile and a formal eye-field test. Acoustic neuromas need a hearing test.
Treatment options
- Observation with scans, for small tumours that are not growing or causing symptoms
- Medicines for some hormone-secreting pituitary tumours, which can shrink them without surgery
- Endoscopic surgery through the nose for many pituitary and front-of-skull-base tumours, with no cut on the face or scalp
- Open skull base surgery through a carefully planned opening, when the tumour is in a position the endoscope cannot reach safely
- Radiosurgery such as Gamma Knife, for selected small tumours or what is left after surgery
Why training matters here
Dr Gupta completed a research fellowship in cerebrovascular and skull base neurosurgery at the Arkansas Neuroscience Institute in Little Rock, USA, after his MCh at NIMHANS. His Yashoda profile lists open and endoscopic skull base surgery among his main areas of work, done with neuronavigation and monitoring of the cranial nerves during the operation.
In skull base surgery, the decision of what not to remove matters as much as what to remove. Leaving a small piece stuck to a nerve and treating it later with radiosurgery is often the better result for the patient than complete removal at the cost of the nerve.
Recovery
After endoscopic pituitary surgery most patients go home in a few days, with nasal care instructions and hormone checks for some weeks. Open skull base operations need a longer stay. Follow-up MRI scans continue for years, because some of these tumours can come back slowly.
Questions
Can a pituitary tumour be removed without opening the skull?
Often, yes. Many pituitary tumours are removed endoscopically through the nose, with no cut on the face or scalp. Whether that is right for a particular tumour depends on its size and shape on the MRI.
Will I lose my hearing after acoustic neuroma treatment?
It depends on the size of the tumour and how much hearing is left before treatment. Small tumours can often be watched or treated with radiosurgery. This is a question to go through with your scans in front of the surgeon.
Does a pituitary tumour always need surgery?
No. Some hormone-secreting pituitary tumours, especially prolactinomas, usually respond to tablets. Small tumours that are not secreting hormones or pressing on the nerves for sight can be watched.
About Dr Gupta
This page explains the condition in general terms and is written for patients and families. It is not a diagnosis. Decisions about treatment are made in consultation, with your scans. In an emergency, go to the nearest hospital emergency department.