Skull Base Tumours: Comprehensive Cancer Information

Skull Base Tumours: A Comprehensive Guide

This information is intended to provide a general overview of skull base tumours. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.

General Information

The skull base is a complex and crucial area located behind the eyes and nose, forming the floor of the skull and acting as a wall between the brain and the face. Many essential structures, including nerves, major blood vessels, and the spinal cord, pass through the openings in the skull base.

Several different types of tumours can originate in or extend into this critical area. These tumours can be malignant (cancerous) or benign (non-cancerous). Even benign tumours can cause significant symptoms or pose a serious risk to the patient's health and well-being due to their proximity to vital structures.

At SSCHRC, our expert physicians and specialists in the Skull Base Tumour Program work collaboratively to treat patients with both cancerous and non-cancerous tumours of the skull base.

Classifying Skull Base Tumours

Skull base tumours are typically classified in two ways:

Location

Based on their specific site within the head.

Tumour Type

Based on the cell structure and identifying characteristics of the tumour itself.

The precise tumour type is determined during the patient's diagnostic workup. Radiologists and pathologists who specialise in head and brain tumours work closely with head and neck surgeons and neurosurgeons to establish a definitive tumour type. This determination, along with the patient's unique health profile, allows the skull base team to specifically tailor the treatment plan to each individual.

Symptoms

Skull base tumours may not cause any noticeable symptoms until they have grown to a substantial size. The specific symptoms a person experiences can vary depending on the tumour's location and how quickly it is growing.

Skull base tumour symptoms may include:

  • • Facial pain or numbness
  • • Facial weakness or paralysis
  • • Headache
  • • Recurrent sinus problems
  • • A stopped-up (blocked) nose
  • • Loss of the sense of smell
  • • Nosebleeds
  • • Vision loss
  • • Double vision
  • • Hearing loss
  • • Ringing in the ears (tinnitus)
  • • Dizziness, vertigo, or loss of balance
  • • Shortness of breath
  • • Hoarseness or losing your voice
  • • Difficulty swallowing and frequent choking
  • • Lumps on the neck

It is important to remember that having one or more of these symptoms does not confirm a skull base tumour. If you experience any of these signs, you should consult your doctor, as they may indicate other health problems.

In some instances, skull base tumours can be inherited, meaning they are passed down from one generation to the next. Genetic counselling may be beneficial for you to understand the potential risk to yourself and your family.

Diagnosis

Patients at SSCHRC with tumours of the skull base receive a complete diagnostic evaluation, followed by treatment and follow-up care using the latest techniques and equipment. Given the unique characteristics of each tumour type and patient, our skull base experts carefully tailor the diagnostic methods and treatment regimens to provide the most precise care.

Skull Base Tumour Diagnostic Tests

If you have symptoms that may suggest a skull base tumour, your doctor will perform an examination and ask detailed questions about your health and symptoms. Our team of experts will then carefully select the tests best suited for your specific tumour.

Radiologists and pathologists with special expertise in head, neck, and brain tumours work alongside your doctor to determine the tumour type based on your diagnostic test results. One or more of the following tests may be used to find out if you have a skull base tumour and whether it has spread:

Imaging Exams

Imaging exams allow doctors to accurately identify the presence and location of tumours. The following may be used for skull base tumours:

  • CT or CAT (Computed Axial Tomography) scans: Uses an X-ray machine to take several pictures from different angles, creating a highly detailed image.
  • MRI (Magnetic Resonance Imaging) scans: Uses magnetic fields and radio waves to generate detailed pictures of the body's soft tissue and organs.
  • PET (Positron Emission Tomography) scans: A small dose of radioactive sugar is injected into the patient. A scanner tracks where the body distributes the sugar, which helps radiologists find cancer cells in the body.
  • Angiogram: Creates detailed images of the body's blood flow and blood vessels.

Biopsy

During a biopsy, a small tissue sample is removed and examined under a microscope for the presence of cancer cells. Depending on the tumour's location, some biopsies can be done as an outpatient procedure with only local anaesthesia. In other cases, patients may require a surgical biopsy under general anaesthesia. Biopsy methods for skull base tumours include:

  • Fine-needle aspiration (FNA): Removes suspected cancer cells with a thin needle.
  • Endoscopic biopsy: A thin, long tube with a camera and a tool on the end is inserted through the nose and sinuses. The doctor locates the tumour and removes a piece for examination.
  • Biopsy from the ear using a microscope.
  • Surgical biopsy.

Functional Testing

Functional testing shows how certain parts of the brain, head, and neck are working. These tests are selected based on your symptoms and the tumour's location in the skull base. They may include:

  • Hearing tests (e.g., audiogram, auditory brainstem response, ABR)
  • Balance tests (e.g., videonystagmography, rotary chair testing)
  • Vision tests
  • Videostroboscopy of vocal cord function
  • Swallowing tests, including a modified barium swallow
  • Neurocognitive evaluation to test for memory and cognition changes
  • Hormone testing
  • Smell testing

As some cases of skull base tumours can be hereditary, genetic counselling may be right for you. Learn more about the risk to you and your family on our dedicated genetic testing page.

Treatment

The specialists at SSCHRC employ a comprehensive team approach to skull base tumours, bringing together exceptional expertise from neurosurgery, head and neck surgery, plastic surgery, medical oncology, radiation oncology, and many other areas. We personalise your treatment to deliver the most advanced care with the least possible impact on your body.

Our Treatment Approach

Skull base tumour patients benefit from advanced technology and treatments. Your recommended therapy may include:

  • Minimally invasive surgical techniques, including endoscopic endonasal surgery, keyhole craniotomies, and endoscopic transorbital approaches
  • Advanced open surgical techniques
  • Radiation therapy treatments, including stereotactic radiotherapy and radiosurgery, and innovative imaging and delivery techniques
  • Advanced reconstruction surgeries
  • Chemotherapy, targeted therapy, and immunotherapy

We are also constantly engaged in research for newer, safer, and more advanced treatments for skull base tumours, allowing us to offer a range of clinical trials for new therapies.

Selecting Your Treatment

If you are diagnosed with a skull base tumour, your doctor will discuss the best treatment options, which depend on:

  • The type of tumour
  • The location and extent of the tumour
  • Possible side effects of the treatment
  • Your overall health

Most skull base tumours require some form of surgery. Some can be treated effectively without surgery (e.g., with radiation or chemotherapy). Others may not require immediate treatment and can be closely monitored over time under the care of an experienced skull base specialist. Your treatment will always be customised to your particular needs and may include one or more of the following options.

Surgery

Like all major operations, skull base tumour surgery is most successful when performed by a surgeon with extensive experience in the specific procedure.

SSCHRC's renowned skull base tumour surgeons work in multi-specialty teams. They perform numerous skull base tumour surgeries each year, utilising the most advanced techniques to select the surgical approach that is best tailored to each patient.

The main types of skull base tumour surgery include:

  • Open Surgery: Incisions are made in the skin or the membranes of the nose, mouth, or throat to expose the bone of the skull base. The incision can often be hidden in the hair, skin creases, nose, or mouth. The affected bone is removed to expose the tumour and identify important nerves and blood vessels. After the tumour is removed, the membrane protecting the brain and surrounding soft tissues is closed to seal off the skull base. For large tumours, plastic surgeons may rebuild the soft tissues and bone to optimise function and appearance. Highly specialised plastic surgeons may also provide facial reanimation and complex craniofacial reconstruction when muscles and nerves are affected.
  • Minimally Invasive Endoscopic Surgery: Using no incisions or just a few small ones (e.g., in the skull, back of the sinuses, or the eyelid crease), the surgeon uses an endoscope to biopsy or remove the tumour. By taking advantage of natural corridors such as the nasal cavity or along the orbit, these procedures may lessen damage to healthy tissue, lessen time spent in the hospital and recovery time, and reduce complications.
  • Image-Guided Surgery: CT or MRI scans are taken before surgery and used in the operating room to help guide the surgeon to the precise location of the tumour. This enhances the accuracy, precision, and safety of the surgery.
  • Real-Time MRI: Provides surgeons with precise, "live" images of the tumour and surrounding areas during the operation. This increases the surgeon's accuracy and the chance for complete removal of the tumour.

Radiation Therapy

Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques that doctors can use to accurately target a tumour while minimising damage to healthy tissue.

The types of radiation used to treat skull base tumours include:

  • Stereotactic Radiotherapy (SRT): A non-invasive treatment that uses dozens of highly focused radiation beams to deliver large radiation doses precisely to the shape of the tumour. SRT uses high-resolution 3D imaging and a specialised coordinate system to accurately map the tumour, minimising impact on surrounding normal tissue. Treatment is usually performed in one to five sessions.
  • Fractionated Stereotactic Radiotherapy: A type of stereotactic therapy used when multiple treatments (usually three to five) are needed. It is used when a tumour is too large for a single stereotactic treatment or is very close to a critical organ.
  • Stereotactic Radiosurgery (SRS): A type of SRT, this is a non-invasive treatment that uses dozens of tiny radiation beams to accurately target tumours with a single, high dose of radiation. Despite its name, SRS is not a surgical procedure and does not require an incision or anaesthesia. It is effective for treating small tumours in the head and neck that are difficult to reach by surgery, or for patients who cannot tolerate surgery or have had previous radiation therapy to the brain.
  • Reirradiation: The goal of skull base reirradiation is to provide long-term cancer control while also preserving the patient's quality of life. Repeat radiation in an area that has already received treatment is very challenging, requiring precise and accurate delivery to avoid unnecessary reirradiation of normal tissue. It is critical that the radiation oncologist and team have experience with skull base tumour reirradiation. SSCHRC is a leader in head and neck reirradiation. Advanced techniques such as IMRT/VMAT and stereotactic radiosurgery can be used to reirradiate tumours when surgery is not possible.
  • Palliative Reirradiation: Stereotactic reirradiation of the skull base can be used to provide symptom relief, for example, from facial pain caused by cancer.

Chemotherapy

Chemotherapy drugs are used to kill cancer cells, control their growth, or relieve disease-related symptoms. Treatment may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.

Immunotherapy

The immune system naturally defends the body from infection and disease. Cancer is a complex disease that can evade the immune system. Immunotherapy improves the immune system's ability to find and eliminate the cancer. Skull base tumours may be treated with immune checkpoint inhibitors, a type of immunotherapy that keeps the immune system "turned on" against the tumour.

Targeted Therapy

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer at a cellular level. Cancer cells need specific molecules (often proteins) to survive, multiply, and spread. Targeted therapies are designed to interfere with, or target, these cancer-promoting molecules.

Skull Base Tumour Clinical Trials

Due to its status as a premier cancer centre, SSCHRC leads numerous innovative clinical trials (research studies) for skull base tumours. Studies of new treatments based on tumour cell type may include laboratory or imaging tests to monitor treatment effectiveness. Other studies track the quality of life of patients and their families, which can help lessen the effect of the tumour and its treatment on the patient's physical, mental, and social well-being.

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