Skull base surgery is a multi-disciplinary effort which combines the skills of otolaryngology, neurosurgery, neuro-radiology, anesthesia, intensive care medicine, and physical and rehabilitative medicine with corresponding skilled nursing care to diagnose and treat lesions of the anterior, middle and posterior base of skull. The diseases which present in this location may be benign or malignant. The term “skull base surgery” encompasses an approach to many different diseases found in this area.
A skull base center (or cranial base center) is an idea as well as a reality. A skull base center is a team-approach which is used to care for very special patients with difficult diseases at the base of the skull. It has been recognized that no one physician, surgeon or nurse can provide the total amount of care which these patients require. Therefore, the combined skills and efforts of many professionals have been joined in concert to provide the complete care for the patient.
Depending upon the nature of the disease, this team may consist of an otolaryngologist, a neurosurgeon, a radiologist, an intensivist, the anesthesiologist, skilled nurses both in the intensive care unit and on the floor, as well as the physicians and nurses in rehabilitative and physical medicine.
This surgery is performed either at The New York Eye & Ear Infirmary, Saint Vincent’s Medical Center of New York, or at Roosevelt Hospital. The nature of the disease itself will determine where surgery will be scheduled. Lesions which do not pass beyond the dural lining of the brain can be cared for at The New York Eye & Ear Infirmary. Lesions which pass beyond the dura are usually done at one of the other facilities.
A team approach is used to care for patients with disease of the skull base. Ordinarily, the team is comprised of the neurosurgeon and otolaryngologist. Occasionally, an interventional radiologist will be called upon to embolize vascular tumors prior to surgery. In selected cases, the radiation oncologist will join the surgeons to initiate therapy for malignant tumors.
These cases are ordinarily scheduled for an entire day. An average case may last from 6-10 hours and occasionally longer. In selected instances, a case must be staged with several surgeries planned over a period of several weeks or months.
The patient must be thoroughly diagnosed prior to surgery. Although each patient is unique, the ordinary diagnostic tests which are required to both establish a diagnosis and help plan surgery are a computed tomogram (CT scan), magnetic resonance imaging and/or magnetic resonance angiography (MRI/MRA), tests of hearing, balance and facial nerve function, blood tests, and, in certain cases, a biopsy prior to surgery. For diseases which are of vascular origin, the patient may require angiography as well as embolization prior to surgery.
Each member of the skull base team is keenly aware that these necessary tests are expensive. Every effort is made to order only those tests which are will actually contribute to the care of the patient and never to duplicate tests unnecessarily. This is an advantage of the skull base team: each member works together as part of the team, understanding how another member is proceeding with the care of the patient.
In addition to those services mentioned above, the patient will have general medical and nursing care. The services of pathology are needed in every case to confirm tumor diagnosis. Other physicians or surgeons may be consulted as necessary.
The length of hospitalization will depend upon the disease itself. An average length of stay for skull base tumors is between 4 and 10 days. If a post-operative problem should arise, or if post-operative rehabilitation is required, the hospital stay will be longer. No patient is ever discharged form the hospital until he or she is able to care for himself or herself. If a visiting nurse or other home health care aid is required, this is arranged before discharge through the hospital’s department of social services.