Skull Base Tumor Treatment & Surgery

The most advanced methods of brain tumor diagnosis and treatments are performed at the Cushing Neuroscience Institute's Skull Base Center at North Shore-LIJ Health System. The Skull Base Center specializes in the diagnosis and treatments of skull base brain tumors and disorders of the veins and arteries of the skull base. A skull base disorder is usually diagnosed by having one or more of the following tests:

MRI Scan (Magnetic Resonance Imaging)
This test produces clear and detailed pictures of the body without using x-rays. An MRI scan is the best and easiest way of diagnosing any skull base tumor, especially meningiomas, acoustic neuromas and pituitary adenomas. MRI scans are one of the best brain tumor diagnosis tests for showing the detail of soft tissues such as brain, nerves and muscles.

CT Scan (Computerized Tomography)
This is a method of body imaging that uses special x-ray equipment to create a detailed cross-section picture of body tissues and organs. CT scans are one of the best brain tumor diagnosis tests for finding skull base tumors, particularly those that affect the bone of the skull base, such as meningiomas and chordomas. CT scans are very good at showing details related to bone changes. Patients with skull base disorders commonly have both a MRI scan to examine the soft tissues and a CT scan to examine the bone changes.

Cerebral Angiography
Cerebral angiography gives a detailed picture of the blood vessels that supply and surround the brain and skull. Skull base brain tumors often displace these vessels, and this shift in location often pinpoints the location of the growth. The information from a cerebral angiogram is very important in planning your treatment. Our team of interventional neuroradiologists is often able to decrease the blood supply to these tumors before surgery, thus allowing for a safer surgery.

Since skull base brain tumors may affect hearing, it is common for patients to have an audiogram or hearing test before and after treatment, in addition to other examinations for brain tumor diagnosis. You will be asked to place special headphones on and tell the staff what you are able to hear at different volume settings.

Neuro-Ophthalmology Evaluation
Skull base brain tumors also affect the field of vision or the nerves that control the movement of your eyes. It is important for us to measure your eye function and vision before and after treatment. A neuro-ophthalmologist is an eye doctor who specializes in disorders of the eye that are caused by disorders of the brain, brainstem and cranial nerves.

Endocrinology Evaluation
In addition to other tests for brain tumor diagnosis, patients with pituitary tumors will need an evaluation and follow-up with an endocrinologist. An endocrinologist is a doctor who specializes in identifying and treating disorders that affect the glands that produce your hormones. The endocrinologist can determine if there are any changes in your hormone levels.

Brain Tumor Treatment and Skull Base Disorders Treatment

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

Surgical Removal
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. The neurosurgery team at the Skull Base Center will work to reach the tumor or area of interest, then carefully remove and dissect it away from the surrounding structures.

Intra-operative MRI scanning at North Shore University Hospital can provide real-time images throughout the brain tumor surgical treatment to help remove brain tumors safely and effectively. Surgery for skull base brain tumors may take anywhere from 6 to 12 hours depending upon the type of tumor and type of operation.

Endoscopic Skull Base and Pituitary Surgery
Certain skull base brain tumors, particularly pituitary tumors and those tumors located towards the front part of the skull can be treated and removed endoscopically. Transsphenoidal surgery is carried out through the sphenoid sinus (located directly behind the nose) without entering the brain cavity itself. Pituitary tumors and certain meningiomas are just two of the brain tumor types that are removable using the non-invasive endoscopic approach for brain tumor treatment.

While the patient is under anesthesia, the endoscopic surgeon at the Skull Base Center will place a small endoscope (about the diameter of a pea) through one nostril. The endoscope has a powerful camera at the end of it which allows the surgeon to view the area directly. The surgeon is then able to use small micro-instruments placed through the right and left nostril to carefully remove the tumor. Once the tumor is removed, the floor of the skull base is repaired and the endoscope is removed.

As a brain tumor treatment, endoscopic surgery is less invasive than traditional open surgical techniques and results in a faster, less painful recovery for the patient. The endoscope also allows the surgeon to see areas all around the tumor.  Surgery for most pituitary tumors takes about three hours.

After an endoscopic tumor removal, some patients may need to take hormone replacements, which will be discussed with your endocrinologist at your post-operative visit. If the tumor is able to be fully removed, no further treatment, other than routine follow-up MRIs, is required.

3D Endoscopic Surgery
The specialists at the Skull Base Center have pioneered the use of the Visionsense VSII three-dimensional (3D) endoscope camera system to remove pituitary tumors. This technology allows the surgeon to precisely locate the tumor and view it clearly in 3D, so that the tumor can be completely and safely removed. The 3D camera sensor is a microchip located at the end of the endoscope, only a few millimeters from the surgical field. With this 3D miniature camera system, the surgical team wears special 3D glasses, such as those used to view 3D movies in theaters. 

Radiosurgical Treatment
Some skull base brain tumors are better treated with radiosurgery. Radiosurgery involves giving a single, high dose of radiation to a specific area. Radiosurgery as a 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
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, percutaneous stereotactic rhizotomy and radiosurgery. Your doctor will explain each treatment, and together you will decide which one will be the best and safest for you.

  • 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.

All skull base surgery patients are treated in the Neurosurgical Intensive Care Unit at North Shore University Hospital after surgery.

Make an appointment at our Skull Base Center
Cushing Neuroscience Institute’s Skull Base Center makes it easy for you to take the first steps in ensuring the best neurological care for yourself and your family. Simply email us at, or call us at  844-56Neuro (844-566-3876). You may also fill out our Request an Appointment form.