Schädelbasistumor

A skull base tumor is a growth that forms in the bones and spaces at the bottom of the skull, under the brain, near the eyes, ears, nose, and major nerves and blood vessels. These tumors can be non‑cancerous or cancerous, and even benign ones can cause serious symptoms because of the tight, crowded area where they grow.

1) What is this condition?

It is a lump or mass that develops in the area of bone and tissue forming the “floor” of the skull, beneath the brain and behind the eyes and nose.
Tumors can arise from bone, nerve coverings, glands (like the pituitary), or nearby structures, and include types such as meningiomas, schwannomas, pituitary tumors, chordomas, and others.
Because many important nerves and blood vessels run through this area, even small tumors can affect vision, hearing, balance, facial movement, swallowing, or sense of smell.

2) How serious is it?

Seriousness depends on tumor type (benign vs cancerous), size, speed of growth, and exact location relative to brainstem, nerves, and arteries.
Many skull base tumors are benign and slow‑growing, but can still cause progressive nerve damage or brain compression if not treated.
Malignant skull base tumors are less common but can be life‑threatening and usually need a combination of surgery and high‑dose radiation.

3) Non‑surgical treatments

Watchful waiting with regular scans and check‑ups for small, slow‑growing, symptom‑free tumors, especially in older or fragile patients.
Radiation therapy (including focused radiosurgery, intensity‑modulated radiation, or proton/particle therapy) to shrink or control tumors, often used when surgery is risky or to treat remaining tumor after surgery.
Drug treatments (chemotherapy, targeted drugs, or immunotherapy) for certain cancerous skull base tumors.
Symptom‑based care: pain management, eye care, hearing aids, swallowing therapy, and physical therapy for balance.

4) Types of surgery that may be needed

Traditional open skull base surgery through the scalp and sometimes face, creating a bone opening to reach deep tumors.
Minimally invasive endoscopic surgery through the nose (endoscopic endonasal approach) using a camera and long instruments to reach tumors under the brain or near the pituitary.
Combined approaches (open plus endoscopic) for large, complex, or widely spread tumors crossing several regions.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Control or slow tumor growth while avoiding high‑risk operations, especially in delicate locations or in high‑risk patients.
- Ease symptoms and preserve function (vision, swallowing, balance, facial movement) with radiation and supportive therapies.
Surgery goals:
- Remove as much tumor as safely possible to relieve pressure on the brainstem and nerves.
- Obtain tissue to confirm the exact tumor type and guide any needed radiation or medications.

6) How surgery can “fix” the problem

By taking out tumor tissue, surgery opens up crowded spaces, reducing pressure on the brain, brainstem, and nerves controlling vision, hearing, and facial movement.
Endoscopic surgery through the nose can directly reach tumors under the brain with smaller openings, often resulting in less pain, fewer visible scars, and faster early recovery.
Even when complete removal is not possible, “debulking” (partial removal) can make later radiation safer and more effective.

7) Risks of surgery (general and specific)

General risks: bleeding, infection, blood clots, and anesthesia problems.
Skull base–specific risks:
- Leakage of clear brain fluid (CSF leak) from the nose or wound, sometimes leading to infection (meningitis).
- Injury to cranial nerves causing double vision, facial numbness or weakness, hearing loss, swallowing trouble, or voice changes.
- Stroke or serious bleeding if major arteries are injured.
- For operations near the pituitary, hormone problems such as diabetes insipidus or low hormone levels.

8) Chances this surgery will work

For many benign skull base tumors, experienced teams can often remove most or all of the tumor with good long‑term control, especially when combined with focused radiation if needed.
For rare tumors like chordomas or chondrosarcomas, combining aggressive surgery with high‑dose proton or carbon‑ion radiation can achieve 5‑ to 9‑year survival rates above 75–90% in some series.
Success is strongly tied to tumor type, size, location, and the expertise of the skull base surgery team.

9) Possible complications from the surgery

Early complications: CSF leak, meningitis, temporary or lasting vision changes, new weakness or numbness, nose and sinus problems, and hormone changes for tumors near the pituitary.
Delayed complications: chronic sinusitis, long‑term hormone deficits, persistent nerve deficits (e.g., facial weakness, swallowing trouble), or need for repeat surgery.
Residual or recurrent tumor that may require additional surgery or radiation years later.

10) Typical recovery from the condition

Without treatment, skull base tumors often slowly worsen, leading to increasing pain, vision or hearing loss, facial weakness, or balance and swallowing problems.
With treatment, many patients see improvement or stabilization of key functions (like vision or balance), but some nerve damage may be permanent.
Fatigue, mood changes, and adaptation to any lasting deficits are common and often need rehab and psychosocial support.

11) Typical recovery after surgery

First days to week: hospital stay (often ICU at first), headaches, nasal congestion (for endoscopic surgery), and careful monitoring for leaks, infections, and nerve function.
First weeks: gradual return to light activity; restrictions on heavy lifting, nose‑blowing, or strenuous exercise while bone and soft tissues heal.
First months: rehabilitation (physical, occupational, speech/swallow therapy) often needed to maximize recovery of balance, strength, and swallowing; improvements may continue for many months.

12) How long in the hospital

Many endoscopic skull base surgeries require about 3–5 days in the hospital if there are no major complications.
Larger open surgeries or cases with complications may involve longer stays and sometimes transfer to a rehab unit before going home.

13) Long‑term outlook

For benign skull base tumors, long‑term survival is generally very good, though life‑long monitoring is needed for regrowth and late radiation effects.
For certain rare malignant tumors (like chordomas and chondrosarcomas), modern surgery plus proton or carbon‑ion therapy offers 5‑ to 9‑year survival in the range of 75–90% in specialized centers.
Quality of life often depends more on nerve function (vision, swallowing, facial movement) than on the tumor itself, highlighting the importance of experienced teams and rehab.

14) Need for outpatient follow‑up

Lifelong follow‑up with MRI or CT scans is usually recommended to watch for tumor regrowth or new changes.
Regular visits with neurosurgery, ENT/skull base specialists, and sometimes radiation and medical oncologists are needed to manage symptoms and late effects.
Many patients also need ongoing eye exams, hearing checks, hormone testing (for pituitary‑adjacent tumors), and therapy for speech, swallowing, or balance.