Skull base tumors: Viewpoint—surgery

Abstract

Tumors of the skull base have historically posed a unique surgical challenge. The abundance of critical neurovascular structures in this region necessitates a distinct balance between the goals of maximal tumor removal and avoidance of neurological deficits. A number of these lesions do not have a set standard treatment paradigm, thus requiring a highly personalized plan of care based around the individual patient. Surgical resection of these lesions has the benefit of allowing direct decompression of the neurovascular elements, potentially leading to significant clinical improvement. Additionally, in a number of scenarios, surgery may be the only treatment option that offers a cure. On the other hand, the primary goal of stereotactic radiosurgery is tumor control, preventing further growth of an existing tumor or residual lesion. The desired therapeutic intervention should be determined based on various factors including the individual patient’s age, symptoms, comorbidities, tumor location, and extent of the involvement of surrounding neurovascular structures. This chapter discusses the surgical considerations for a variety of skull base tumors, including indications for surgery, surgical approaches, and patient outcomes. Due to the variability in location, natural history, and clinical presentation of skull base tumors, the discussion will illustrate the different surgical considerations for specific tumors, including trigeminal schwannomas, glomus jugulare tumors, chordomas, chondrosarcomas, esthesioneuroblastomas, craniopharyngiomas, and skull base meningiomas.