Acoustic Neuroma and Skull Base Tumors

The skull is composed of bones and cartilage that form the face and the cranium, which surrounds the brain. The five bones that form the bottom, or skull base, of the cranium also form the eye socket, roof of the nasal cavity, some of the sinuses, and the bones that surround the inner ear.

The skull base is a crowded area with openings that the spinal cord, many blood vessels, and nerves all pass through. Neural (nerves) and vascular structures (blood vessels) traverse multiple foramina (openings) throughout the skull base. It is a very intricate and complex anatomical region that supports the undersurface of the brain and protects many vital structures.

Skull base surgery refers to state-of-the-art minimally invasive surgical techniques used to reach areas in the skull base with minimal or little injury of the surrounding structures. This allows surgeons to reach the tumor in a safe and faster surgery with fewer complications and a faster recovery period. Minimally invasive techniques are used to maximize tumor removal while preserving neurological function to the greatest extent possible.

Otolaryngology surgeons at Brigham and Women’s Hospital (BWH) specialize in surgical techniques for acoustic neuromas (also known as vestibular schwannoma) and skull base surgery. We offer the most current diagnostic methods and proven treatments, including minimally invasive surgical approaches aided by video technology. We are part of the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.

Learn more about skull base tumors.
Read the Otolaryngology Advances article about the BWH Skull Base Surgery Program.

Acoustic Neuroma and Skull Base Tumors Topics

Types of Skull Base Tumors

The multidisciplinary skull base team at Brigham and Women’s Hospital (BWH) treats a variety of skull base tumors, benign and malignant.

Benign (non-cancerous) tumors managed by our multidisciplinary skull base team include:

  • Acoustic neuroma (also called vestibular schwannoma)
  • Meningioma
  • Encephaloceles with or without cerebral spinal leak
  • Schwannomas of the facial nerve
  • Cholesteatomas
  • Epidermoids
  • Glomus (also called paragangliomas) jugulare and vagale
  • Cholesterol granulomas
  • Pituitary tumors
  • Temporal bone tumors
  • Many others

Malignant (cancerous) tumors managed by our multidisciplinary skull base team include:

  • Squamous cell carcinoma involving the skull base and temporal bone
  • Chondrosarcoma
  • Chordoma
  • Endolymphatic sac tumors
  • Esthesioneuroblastomas
  • Inflammatory pseudotumors of the skull base
  • Metastatic disease
  • Many others
Diagnosis of Skull Base Tumors

The diagnosis of growths or abnormalities that may require skull base surgery is based on your symptoms and a physical exam. Because this area cannot be seen directly, these exams and imaging studies are important parts of the diagnosis:

  • An MRI of the brain and/or skull base, with and without gadolinium contrast, is performed to diagnose tumors of the skull base with little risk to the patient.
  • A CT-scan of the skull base or temporal bone may also be needed to evaluate the surrounding skull base bone.
  • A magnetic resonance angiogram (MRA) or magnetic resonance venogram (MRV) can be useful to study how the blood vessels to the brain are affected by the tumor.
  • For large or very vascular tumors, an angiogram with embolization may be performed prior to surgical resection in order to plug the arteries that feed the tumor. This reduces blood loss during surgery.

Learn more about diagnostic tests for neurologic disorders.

Treatment for Skull Base Tumors

Surgery

Skull base surgery may be done to remove both benign and cancerous growths, and abnormalities on the underside of the brain or the skull base. During this minimally invasive procedure, instruments are inserted through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery is managed by the multidisciplinary skull base team at BWH.

Before minimally invasive skull base surgery was developed, the only way to remove growths in this area of the body was by making an opening in the skull. Under some circumstances, this type of surgery may be necessary.

Constant communication amongst the skull base team helps to ensure preservation of neural (nerves) and vascular (blood vessels) structures surrounding the tumor during microsurgery. The team also includes a dedicated neurophysiology team who monitor in real-time the integrity and health of the patient’s nerves while undergoing surgery.

The latest 3-D imaging guidance technology ensures the surgeons ability to reach all areas of the skull base with accurate knowledge of individual anatomical structures surrounding the tumor.

Non-Surgical Treatment

In addition to minimally invasive and open skull base surgery, these treatments may be needed, depending on the type of growth or abnormality of the skull base:

  • Chemotherapy. These are drugs used to treat growths caused by cancer.
  • Radiation therapy. X-ray treatment may be used to control a growth in the skull base that cannot be completely removed by surgery.
  • Gamma knife. This is a special type of radiation therapy that uses precise X-ray beams to target a growth in the skull base.

Learn more about treatment for skull base diseases.

What You Should Expect

A Brigham and Women’s Hospital otolaryngologist will begin with a complete evaluation and assessment of your specific condition. As part of the assessment, we will establish which treatment is indicated. A customized treatment plan will be established and you will work with the appropriate BWH services.

Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

If surgery is needed, you will be taken care of in the operating room by an experienced otolaryngology surgeon. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our otolaryngologists are faculty members at Harvard Medical School and active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the ear, nose and throat.

Resources

Go to our health library to read more about skull base diseases.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Learn about the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

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