Skull Base Tumors: Surgery Perspective

  • James K. Liu
  • Oren N. Gottfried
  • William T. Couldwell


Tumors of the skull base are frequently intimately involved with surrounding critical neurovascular structures, which makes complete resection difficult. Because tumors of the skull base can extend into adjacent compartments, both intracranial and extracranial structures can be involved. Thus, a multidisciplinary approach is required for optimal surgical management. Because of advancements in microsurgical techniques, modern skull base approaches, electrophysiologic monitoring, and neuroimaging in the past two decades, many of these tumors that were once thought to be inaccessible and unresectable can be safely removed with preservation of neural structures [1]. The microsurgical application of skull base techniques maximizes bone removal and therefore improves the operative field of vision, minimizes brain retraction, and provides multiple surgical angles for dissection [2]. Recent applications of frameless stereotaxy and endoscopic techniques have further contributed to modern skull base surgery. The primary goals of surgical removal of skull base tumors are to preserve neurologic function while treating the patient’s pathology. The ultimate goal is cure by gross total tumor resection with minimal morbidity and mortality.


Skull Base Cavernous Sinus Stereotactic Radiosurgery Glomus Tumor Gamma Knife Radiosurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nanda A, Jawahar A, Sathyanarayana S. Microsurgery for potential radiosurgical skull base lesions: a retrospective analysis and comparison of results. Skull Base 2003;13(3):131–138.CrossRefPubMedGoogle Scholar
  2. 2.
    Bulsara KR, Al-Mefty O. Skull base surgery for benign skull base tumors. J Neurooncol 2004;69(1–3):181–189.CrossRefPubMedGoogle Scholar
  3. 3.
    Pollock BE, Foote RL. The evolving role of stereotactic radiosurgery for patients with skull base tumors. J Neurooncol 2004;69(1–3):199–207.CrossRefPubMedGoogle Scholar
  4. 4.
    Friedman RA, Pensak ML, Osterhaus D, et al. Trigeminal schwannomas: the role of the neurotologist in multidisciplinary management. Otolaryngol Head Neck Surg 1999;120(3):355–360.CrossRefPubMedGoogle Scholar
  5. 5.
    Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg 2002;96(3):453–463.CrossRefPubMedGoogle Scholar
  6. 6.
    McCormick PC, Bello JA, Post KD. Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg 1988;69(6):850–860.CrossRefPubMedGoogle Scholar
  7. 7.
    Pollack IF, Sekhar LN, Jannetta PJ, et al. Neurilemomas of the trigeminal nerve. J Neurosurg 1989;70(5):737–745.CrossRefPubMedGoogle Scholar
  8. 8.
    Shrivastava RK, Sen C, Post KD. Trigeminal schwannomas. In: Winn HR, ed. Youmans Neurological Surgery, 5th ed. Philadelphia: Saunders, 2004:1343–1350.Google Scholar
  9. 9.
    Taha JM, Tew JM Jr, van Loveren HR, et al. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 1995;82(5):719–725.CrossRefPubMedGoogle Scholar
  10. 10.
    Huang CF, Kondziolka D, Flickinger JC, et al. Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery 1999;45(1):11–16; discussion 16.CrossRefPubMedGoogle Scholar
  11. 11.
    Pan L, Wang EM, Zhang N, et al. Long-term results of Leksell gamma knife surgery for trigeminal schwannomas. J Neurosurg 2005;102(Suppl):220–224.CrossRefPubMedGoogle Scholar
  12. 12.
    Nettel B, Niranjan A, Martin JJ, et al. Gamma knife radiosurgery for trigeminal schwannomas. Surg Neurol 2004;62(5):435–444; discussion 44–46.CrossRefPubMedGoogle Scholar
  13. 13.
    Brown JS. Glomus jugulare tumors revisited: a ten-year statistical follow-up of 231 cases. Laryngoscope 1985;95(3):284–288.CrossRefPubMedGoogle Scholar
  14. 14.
    Brewis C, Bottrill ID, Wharton SB, et al. Metastases from glomus jugulare tumours. J Laryngol Otol 2000;114(1):17–23.PubMedGoogle Scholar
  15. 15.
    Bojrab DI, Bhansali SA, Glasscock ME 3rd. Metastatic glomus jugulare: long-term followup. Otolaryngol Head Neck Surg 1991;104(2):261–264.PubMedGoogle Scholar
  16. 16.
    Manolidis S, Shohet JA, Jackson CG, et al. Malignant glomus tumors. Laryngoscope 1999;109(1):30–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Eustacchio S, Leber K, Trummer M, et al. Gamma knife radiosurgery for glomus jugulare tumours. Acta Neurochir (Wien) 1999;141(8):811–818.CrossRefGoogle Scholar
  18. 18.
    Green JD Jr, Brackmann DE, Nguyen CD, et al. Surgical management of previously untreated glomus jugulare tumors. Laryngoscope 1994;104(8 Pt 1):917–921.PubMedGoogle Scholar
  19. 19.
    Jackson CG, McGrew BM, Forest JA, et al. Lateral skull base surgery for glomus tumors: long-term control. Otol Neurotol 2001;22(3):377–382.CrossRefPubMedGoogle Scholar
  20. 20.
    Pareschi RR, Destito S, Raucci AF, Colombo S. Surgery of glomus jugulare tumors. Skull Base 2003;13:149–157.CrossRefPubMedGoogle Scholar
  21. 21.
    Whitfield PC, Grey P, Hardy DG, et al. The surgical management of patients with glomus tumours of the skull base. Br J Neurosurg 1996;10(4):343–350.CrossRefPubMedGoogle Scholar
  22. 22.
    Patel SJ, Sekhar LN, Cass SP, et al. Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. J Neurosurg 1994;80(6):1026–1038.CrossRefPubMedGoogle Scholar
  23. 23.
    Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg 2002;97(6):1356–1366.CrossRefPubMedGoogle Scholar
  24. 24.
    Al-Mefty O, Fox JL, Rifai A, et al. A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas. Surg Neurol 1987;28(6):423–431.CrossRefPubMedGoogle Scholar
  25. 25.
    Gottfried ON, Liu JK, Couldwell WT. Comparison of radiosurgery and conventional surgery for the treatment of glomus jugulare tumors. Neurosurg Focus 2004;17(2):E4.CrossRefPubMedGoogle Scholar
  26. 26.
    Watkins LD, Mendoza N, Cheesman AD, et al. Glomus jugulare tumours: a review of 61 cases. Acta Neurochir (Wien) 1994;130(1–4):66–70.CrossRefGoogle Scholar
  27. 27.
    Jackson CG, Cueva RA, Thedinger BA, et al. Conservation surgery for glomus jugulare tumors: the value of early diagnosis. Laryngoscope 1990;100(10 Pt 1):1031–1036.CrossRefPubMedGoogle Scholar
  28. 28.
    Jackson CG, Cueva RA, Thedinger BA, et al. Cranial nerve preservation in lesions of the jugular fossa. Otolaryngol Head Neck Surg 1991;105(5):687–693.PubMedGoogle Scholar
  29. 29.
    Cece JA, Lawson W, Biller HF, et al. Complications in the management of large glomus jugulare tumors. Laryngoscope 1987;97(2):152–157.CrossRefPubMedGoogle Scholar
  30. 30.
    Gjuric M, Rudiger Wolf S, Wigand ME, et al. Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors. Ann Otol Rhinol Laryngol 1996;105(12):949–954.PubMedGoogle Scholar
  31. 31.
    Saringer W, Khayal H, Ertl A, et al. Efficiency of gamma knife radiosurgery in the treatment of glomus jugulare tumors. Minim Invasive Neurosurg 2001;44(3):141–146.CrossRefPubMedGoogle Scholar
  32. 32.
    Foote RL, Coffey RJ, Gorman DA, et al. Stereotactic radiosurgery for glomus jugulare tumors: a preliminary report. Int J Radiat Oncol Biol Phys 1997;38(3):491–495.PubMedGoogle Scholar
  33. 33.
    Liscak R, Vladyka V, Wowra B, et al. Gamma Knife radiosurgery of the glomus jugulare tumour-early multicentre experience. Acta Neurochir (Wien) 1999;141(11):1141–1146.CrossRefGoogle Scholar
  34. 34.
    Pendl G, Schrottner O, Friehs GM, et al. Radiosurgery with the first Austrian cobalt-60 Gamma-unit. A one year experience. Acta Neurochir (Wien) 1994;127(3–4):170–179.CrossRefGoogle Scholar
  35. 35.
    Jordan JA, Roland PS, McManus C, et al. Stereotastic radiosurgery for glomus jugulare tumors. Laryngoscope 2000;110(1):35–38.CrossRefPubMedGoogle Scholar
  36. 36.
    Maarouf M, Voges J, Landwehr P, et al. Stereotactic linear accelerator-based radiosurgery for the treatment of patients with glomus jugulare tumors. Cancer 2003;97(4):1093–1098.CrossRefPubMedGoogle Scholar
  37. 37.
    Lim M, Gibbs IC, Adler JR Jr, et al. The efficacy of linear accelerator stereotactic radiosurgery in treating glomus jugulare tumors. Technol Cancer Res Treat 2003;2(3):261–265.PubMedGoogle Scholar
  38. 38.
    Feigenberg SJ, Mendenhall WM, Hinerman RW, et al. Radiosurgery for paraganglioma of the temporal bone. Head Neck 2002;24(4):384–389.CrossRefPubMedGoogle Scholar
  39. 39.
    Foote RL, Pollock BE, Gorman DA, et al. Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 2002;24(4):332–338; discussion 8–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Eustacchio S, Trummer M, Unger F, et al. The role of Gamma Knife radiosurgery in the management of glomus jugular tumours. Acta Neurochir Suppl 2002;84:91–97.PubMedGoogle Scholar
  41. 41.
    Liscak R, Vladyka V, Simonova G, et al. Leksell gamma knife radiosurgery of the tumor glomus jugulare and tympanicum. Stereotact Funct Neurosurg 1998;70(Suppl 1):152–160.PubMedGoogle Scholar
  42. 42.
    van der Mey AG, Frijns JH, Cornelisse CJ, et al. Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period. Ann Otol Rhinol Laryngol 1992;101(8):635–642.PubMedGoogle Scholar
  43. 43.
    Colli B, Al-Mefty O. Chordomas of the craniocervical junction: follow-up review and prognostic factors. J Neurosurg 2001;95(6):933–943.CrossRefPubMedGoogle Scholar
  44. 44.
    Crockard A. Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 1996;38(2):420.CrossRefPubMedGoogle Scholar
  45. 45.
    Watkins L, Khudados ES, Kaleoglu M, et al. Skull base chordomas: a review of 38 patients, 1958–88. Br J Neurosurg 1993;7(3):241–248.CrossRefPubMedGoogle Scholar
  46. 46.
    Lanzino G, Dumont AS, Lopes BS, et al. Skull base chordomas: overview of disease, management, options, and outcome. Neurosurg Focus 2001;10(3):E12.CrossRefPubMedGoogle Scholar
  47. 47.
    Crockard HA, Steel T, Plowman N, et al. A multidisciplinary team approach to skull base chordomas. J Neurosurg 2001;95(2):175–183.CrossRefPubMedGoogle Scholar
  48. 48.
    Hug EB, Slater JD. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am 2000;11(4):627–638.PubMedGoogle Scholar
  49. 49.
    Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 1999;91(3):432–439.CrossRefPubMedGoogle Scholar
  50. 50.
    Kondziolka D, Lunsford LD, Flickinger JC. The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial base. Neurosurgery 1991;29(1):38–45; discussion 46.CrossRefPubMedGoogle Scholar
  51. 51.
    Krishnan S, Foote RL, Brown PD, et al. Radiosurgery for cranial base chordomas and chondrosarcomas. Neurosurgery 2005;56(4):777–784; discussion 784.CrossRefPubMedGoogle Scholar
  52. 52.
    Muthukumar N, Kondziolka D, Lunsford LD, et al. Stereotactic radiosurgery for chordoma and chondrosarcoma: further experiences. Int J Radiat Oncol Biol Phys 1998;41(2):387–392.PubMedGoogle Scholar
  53. 53.
    Crockard HA, Cheeseman A, Steel T, et al. A multidisciplinary team approach to skull base chondrosarcomas. J Neurosurg 2001;95(2):184–189.CrossRefPubMedGoogle Scholar
  54. 54.
    Sekhar LN, Chanda A, Chandrasekar K, et al. Chordoma and chondrosarcoma. In: Winn HR, ed. Youmans Neurological Surgery, 5th ed. Philadelphia: Saunders, 2004:1283–1294.Google Scholar
  55. 55.
    Sen CN, Sekhar LN, Schramm VL, et al. Chordoma and chondrosarcoma of the cranial base: an 8-year experience. Neurosurgery 1989;25(6):931–940; discussion 940–941.CrossRefPubMedGoogle Scholar
  56. 56.
    Lanzino G, Sekhar LN, Hirsch WL, et al. Chordomas and chondrosarcomas involving the cavernous sinus: review of surgical treatment and outcome in 31 patients. Surg Neurol 1993;40(5):359–371.CrossRefPubMedGoogle Scholar
  57. 57.
    Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys 2000;47(3):591–596.CrossRefPubMedGoogle Scholar
  58. 58.
    Cantrell RW, Ghorayeb BY, Fitz-Hugh GS. Esthesioneuroblastoma: diagnosis and treatment. Ann Otol Rhinol Laryngol 1977;86(6 Pt 1):760–765.PubMedGoogle Scholar
  59. 59.
    Levine PA, Gallagher R, Cantrell RW. Esthesioneuroblastoma: reflections of a 21-year experience. Laryngoscope 1999;109(10):1539–1543.CrossRefPubMedGoogle Scholar
  60. 60.
    Levine PA, McLean WC, Cantrell RW. Esthesioneuroblastoma: the University of Virginia experience 1960–1985. Laryngoscope 1986;96(7):742–746.PubMedGoogle Scholar
  61. 61.
    Oskouian RJ Jr, Jane JA Sr, Dumont AS, et al. Esthesioneuroblastoma: clinical presentation, radiological, and pathological features, treatment, review of the literature, and the University of Virginia experience. Neurosurg Focus 2002;12(5):e4.CrossRefPubMedGoogle Scholar
  62. 62.
    Bilsky MH, Kraus DH, Strong EW, et al. Extended anterior craniofacial resection for intracranial extension of malignant tumors. Am J Surg 1997;174(5):565–568.CrossRefPubMedGoogle Scholar
  63. 63.
    Eden BV, Debo RF, Larner JM, et al. Esthesioneuroblastoma. Long-term outcome and patterns of failure—the University of Virginia experience. Cancer 1994;73(10):2556–2562.CrossRefPubMedGoogle Scholar
  64. 64.
    Levine PA, Debo RF, Meredith SD, et al. Craniofacial resection at the University of Virginia (1976–1992): survival analysis. Head Neck 1994;16(6):574–577.CrossRefPubMedGoogle Scholar
  65. 65.
    Shah JP, Galicich JH. Esthesioneuroblastoma. Treatment by combined craniofacial resection. N Y State J Med 1979;79(1):84–86.PubMedGoogle Scholar
  66. 66.
    Shah JP, Kraus DH, Bilsky MH, et al. Craniofacial resection for malignant tumors involving the anterior skull base. Arch Otolaryngol Head Neck Surg 1997;123(12):1312–1317.PubMedGoogle Scholar
  67. 67.
    Polin RS, Sheehan JP, Chenelle AG, et al. The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience. Neurosurgery 1998;42(5):1029–1037.CrossRefPubMedGoogle Scholar
  68. 68.
    Sheehan JM, Sheehan JP, Jane JA Sr, et al. Chemotherapy for esthesioneuroblastomas. Neurosurg Clin N Am 2000;11(4):693–701.PubMedGoogle Scholar
  69. 69.
    Diaz EM Jr, Johnigan RH 3rd, Pero C, et al. Olfactory neuroblastoma: the 22-year experience at one comprehensive cancer center. Head Neck 2005;27(2):138–149.CrossRefPubMedGoogle Scholar
  70. 70.
    Unger F, Haselsberger K, Walch C, et al. Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma). Acta Neurochir (Wien) 2005;147(6):595–602.CrossRefGoogle Scholar
  71. 71.
    Unger F, Walch C, Stammberger H, et al. Olfactory neuroblastoma (esthesioneuroblastoma): report of six cases treated by a novel combination of endoscopic surgery and radiosurgery. Minim Invasive Neurosurg 2001;44(2):79–84.CrossRefPubMedGoogle Scholar
  72. 72.
    Walch C, Stammberger H, Anderhuber W, et al. The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment. Laryngoscope 2000;110(4):635–640.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • James K. Liu
    • 1
  • Oren N. Gottfried
    • 1
  • William T. Couldwell
    • 1
  1. 1.Department of NeurosurgerUniversity of UtahSalt Lake CityUSA

Personalised recommendations