Skull Base and Endoscopic Procedures in Cancer Patients

  • Garry BrydgesEmail author
  • Ninotchka Brydges
  • Charles Cowles
Reference work entry


Neurosurgery is a technically complex procedure requiring interdisciplinary teamwork. Neurosurgery around the brainstem offers a higher degree of complexity and substantial risk to postoperative outcomes. Patients with brainstem neoplasms often present with subtle and complex neurological signs and symptoms. Neoplastic tissues of the brain and/or brainstem typically require either typical or atypical neurosurgical approaches to tumor resections. Radiological evaluation often provides substantial information relative to neoplastic consistency, anatomical location, and structural involvement and opportunities to determine the best surgical approach. Depending on the type of neoplasm, comorbidities, location of neoplasm, technical difficulty of the surgical procedure, and perioperative stability determine patient outcomes. Modern neurosurgical approaches have transformed surgical interventions with the use of high-powered intraoperative microscopes, image-guided neuro-navigation systems, nasal endoscopic instruments, and ultrasonic aspirators (Nyquist et al., World Neurosurg 82:S54–S58, 2014). The section will provide a brief overview of the approach to patients with skull base lesions and management throughout the surgical journey.


Neurosurgery Skull base Brainstem neoplasm Endoscopic resection Endoscopic skull base surgery Anesthetics technique Management 


  1. 1.
    Aanerud J, Borghammer P, Rodell A, Jónsdottir KY, Gjedde A. Sex differences of human cortical blood flow and energy metabolism. J Cereb Blood Flow Metab. 2017;37(7):2433–40.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Adesina A, Tihan T, Fuller C, Poussaint T. Atlas of pediatric brain tumors. 2nd ed. Basel: Springer International; 2016.CrossRefGoogle Scholar
  3. 3.
    Ailion AS, Hortman K, King TZ. Childhood brain tumors: a systematic review of the structural neuroimaging literature. Neuropsychol Rev. 2017;27(3): 220–44.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Akcaboy M, Nazliel B, Goktas T, Kula S, Celik B, Buyan N. Whole blood viscosity and cerebral blood flow velocities in obese hypertensive or obese normotensive adolescents. J Pediatr Endocrinol Metab. 2018;31(3):275–81.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Alotaibi NM, Wang JZ, Pasarikovski CR, Guha D, Al-Mufti F, Mamdani M, Saposnik G, Schweizer TA, Macdonald RL. Management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage: time for a consensus? Neurosurg Focus. 2017;43(5):E13.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Ameloot K, De Deyne C, Ferdinande B, Dupont M, Palmers P, Petit T, Eertmans W, Moonen C, Belmans A, Lemmens R, Dens J, Janssens S. Mean arterial pressure of 65 mm Hg versus 85–100 mm Hg in comatose survivors after cardiac arrest: rationale and study design of the neuroprotect post-cardiac arrest trial. Am Heart J. 2017;191:91–8.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Amorocho MC, Fat I. Anesthetic techniques in endoscopic sinus and skull base surgery. Otolaryngol Clin N Am. 2016;49(3):531–47.CrossRefGoogle Scholar
  8. 8.
    Armstead WM. Cerebral blood flow autoregulation and dysautoregulation. Anesthesiol Clin. 2016;34(3): 465–77.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Battal B, Hamcan S, Akgun V, Sari S, Oz O, Tasar M, Castillo M. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance. Eur Radiol. 2016;26(6):1723–31.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Bell S. Idiopathic intracranial hypertension (pseudotumor cerebri). J Neurosci Nurs. 2016;48(6):303–10.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Bond KM, Nasr D, Lehman V, Lanzino G, Cloft HJ, Brinjikji W. Intracranial and extracranial neurovascular manifestations of takayasu arteritis. AJNR Am J Neuroradiol. 2017;38(4):766–72.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Bonnett L, Powell G, Smith C, Marson A. Breakthrough seizures – further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study. PLoS One. 2017;12(12):e0190035.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Brandão LA, Young Poussaint T. Posterior fossa tumors. Neuroimaging Clin N Am. 2016;27(1):1–37.CrossRefGoogle Scholar
  14. 14.
    Brindle KM, Izquierdo-García JL, Lewis DY, Mair RJ, Wright AJ. Brain tumor imaging. J Clin Oncol. 2017;35(21):2432–8.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Bucher J, Koyfman A. Intubation of the neurologically injured patient. J Emerg Med. 2015;49(6):920–7.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Cadena R, Shoykhet M, Ratcliff JJ. Emergency neurological life support: intracranial hypertension and herniation. Neurocrit Care. 2017;27(S1):82–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Caldas JR, Panerai RB, Haunton VJ, Almeida JP, Ferreira GSR, Camara L, Nogueira RC, Bor-Seng-Shu E, Oliveira ML, Groehs RRV, Ferreira-Santos L, Teixeira MJ, Galas FR, Robinson TG, Jatene FB, Hajjar LA. Cerebral blood flow autoregulation in ischemic heart failure. Am J Physiol Regul Integr Comp Physiol. 2017;312(1):R108.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Chen S, Chen M, Cui A, Yu K, Huang C, Zhu M. Risk factors associated with meningitis after neurosurgery: a retrospective cohort study in a Chinese hospital. World Neurosurg. 2018a;111:e546–63.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Chen S, Lotz C, Roewer N, Broscheit J. Comparison of volatile anesthetic-induced preconditioning in cardiac and cerebral system: molecular mechanisms and clinical aspects. Eur J Med Res. 2018b;23(1):10.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    DeWitt JC, Mock A, Louis DN. The 2016 WHO classification of central nervous system tumors: what neurologists need to know. Curr Opin Neurol. 2017;30(6):643–9.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Eisele SC, Reardon DA. Adult brainstem gliomas. Cancer. 2016;122(18):2799–809.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Erwood AA, Velazquez-Vega JE, Neill S, Solomon DA, Butowski N, Nowlan A, Dunbar E, Brat DJ. Chordoid glioma of the third ventricle: report of a rapidly progressive case. J Neuro-Oncol. 2017;132(3):487–95.CrossRefGoogle Scholar
  23. 23.
    Flexman AM, Meng L, Gelb AW. Outcomes in neuroanesthesia: what matters most? Can J Anesth. 2016;63(2):205–11.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Foreman B. The pathophysiology of delayed cerebral ischemia. J Clin Neurophysiol. 2016;33(3):174–82.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Franco V, French JA, Perucca E. Challenges in the clinical development of new antiepileptic drugs. Pharmacol Res. 2016;103:95–104.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Freeman WD. Management of intracranial pressure. Continuum. 2015;21(5(Neurocritical Care)): 1299–323.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Freeman JL, Winston KR, Byers JT, Beauchamp K. Damage-control neurosurgery: packing to halt relentless intracranial bleeding. J Trauma Acute Care Surg. 2015;79(5):865–9.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Gaillard S. The transition from microscopic to endoscopic transsphenoidal surgery in high-caseload neurosurgical centers: the experience of Foch Hospital. World Neurosurg. 2014;82(6):S116–20.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Gefroh-Grimes HA, Gidal BE. Antiepileptic drugs in patients with malignant brain tumor: beyond seizures and pharmacokinetics. Acta Neurol Scand. 2016;133(1):4–16.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Haensel JX, Spain A, Martin C. A systematic review of physiological methods in rodent pharmacological MRI studies. Psychopharmacology. 2015;232(3):489–99.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Hall A, O’Kane R. The best marker for guiding the clinical management of patients with raised intracranial pressure – the RAP index or the mean pulse amplitude? Acta Neurochir. 2016;158(10):1997–2009.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Hanna EY, DeMonte F, editors. Comprehensive management of skull base tumors. New York: CRC Press; 2008.Google Scholar
  33. 33.
    Joosten A, Delaporte A, Ickx B, Touihri K, Stany I, Barvais L, Van Obbergh L, Loi P, Rinehart J, Cannesson M, Van der Linden P. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: a randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology. 2018;128(1):55–66.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Kabré A, Zabsonre DS, Sanou A, Bako Y. The cephaloceles: a clinical, epidemiological and therapeutic study of 50 cases. Neurochirurgie. 2015;61(4): 250–4.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kalani MYS. Intraoperative motor-evoked potential monitoring as a predictive tool for recovery from spontaneous intracerebral hemorrhage. World Neurosurg. 2016;92:546–7.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Kashiwazaki D, Akioka N, Kuwayama N, Noguchi K, Tanaka K, Kuroda S. Pathophysiology of acute cerebrovascular syndrome in patients with carotid artery stenosis: a magnetic resonance imaging/single-photon emission computed tomography study. Neurosurgery. 2015;76(4):427–34.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Komori T. Pathology of oligodendroglia: an overview. Neuropathology. 2017;37(5):465–74.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Lee MJ, Cha J, Choi HA, Woo S, Kim S, Wang S, Chung C. Blood–brain barrier breakdown in reversible cerebral vasoconstriction syndrome: implications for pathophysiology and diagnosis. Ann Neurol. 2017;81(3):454–66.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Limotai C, Go CY, Baba S, Okanari K, Ochi A, Rutka JT, Snead OC III, Otsubo H. Steal phenomenon in Sturge-Weber syndrome imitating an ictal electroencephalography change in the contralateral hemisphere: report of 2 cases. J Neurosurg Pediatr. 2015;16(2): 212–6.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Martínez-Capoccioni G, Serramito-García R, Huertas-Pardo B, García-Allut A, Martín-Martín C. Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge. J Laryngol Otol. 2015;129(4): 358–64.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Medow MS, Kothari ML, Goetz AM, O’Donnell-Smith MB, Terilli C, Stewart JM. Decreasing cerebral oxygen consumption during upright tilt in vasovagal syncope. Phys Rep. 2017;5(10):e13286.CrossRefGoogle Scholar
  42. 42.
    Misra BK, Kirtane MV. Endonasal endoscopic repair is appropriate for defect of the lateral wall of sphenoid sinus. World Neurosurg. 2016;90:615–6.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Nakashima R, Hifumi T, Kawakita K, Okazaki T, Egawa S, Inoue A, Seo R, Inagaki N, Kuroda Y. Critical care management focused on optimizing brain function after cardiac arrest. Circ J. 2017;81(4): 427–39.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Nestler U, Lutz K, Pichlmeier U, Stummer W, Franz K, Reulen H, Bink A, 5-ALA Glioma Study Group. Anatomic features of glioblastoma and their potential impact on survival. Acta Neurochir. 2015;157(2): 179–86.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Ni C, Xu T, Li N, Tian Y, Han Y, Xue Q, Li M, Guo X. Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction. BMC Anesthesiol. 2015;15(1):156.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Nittby HR, Maltese A, Ståhl N. Early postoperative haematomas in neurosurgery. Acta Neurochir. 2016;158(5):837–46.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Nix P, Tyagi A, Phillips N. Retrospective analysis of anterior skull base CSF leaks and endoscopic repairs at Leeds. Br J Neurosurg. 2016;30(4):422–6.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Nyquist GG, Rosen MR, Friedel ME, Beahm DD, Farrell CJ, Evans JJ. Comprehensive management of the paranasal sinuses in patients undergoing endoscopic endonasal skull base surgery. World Neurosurg. 2014;82(6):S54–8.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Ogoh S. Cerebral blood flow regulation during hypoxia. Exp Physiol. 2015;100(2):109–10.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Ogoh S, Washio T, Sasaki H, Petersen LG, Secher NH, Sato K. Coupling between arterial and venous cerebral blood flow during postural change. Am J Physiol Regul Integr Comp Physiol. 2016;311(6):R1255.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Purohit B, Kamli AA, Kollias SS. Imaging of adult brainstem gliomas. Eur J Radiol. 2015;84(4):709–20.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Raybaud C, Ramaswamy V, Taylor MD, Laughlin S. Posterior fossa tumors in children: developmental anatomy and diagnostic imaging. Childs Nerv Syst. 2015;31(10):1661–76.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Ripollés J, Espinosa Á, Casans R, Tirado A, Abad A, Fernández C, Calvo J. Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions. Braz J Anesthesiol. 2015;65(4):281–91.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Schwarz M, Rivera G, Hammond M, Silman Z, Jackson K, Kofke WA. Acousto-optic cerebral blood flow monitoring during induction of anesthesia in humans. Neurocrit Care. 2016;24(3):436–41.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Seule M, Sikorski C, Sakowitz O, von Campe G, Santos E, Orakcioglu B, Unterberg A, Keller E. Evaluation of a new brain tissue probe for intracranial pressure, temperature, and cerebral blood flow monitoring in patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2016;25(2):193–200.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Shibahara I, Kanamori M, Watanabe T, Utsunomiya A, Suzuki H, Saito R, Sonoda Y, Jokura H, Uenohara H, Tominaga T. Clinical features of precocious, synchronous, and metachronous brain metastases and the role of tumor resection. World Neurosurg. 2018;113:e1–9.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Shih RY, Smirniotopoulos JG. Posterior fossa tumors in adult patients. Neuroimaging Clin N Am. 2016;26(4):493–510.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Sokoya M, Mourad M, Ducic Y. Complications of skull base surgery. Semin Plast Surg. 2017;31(4): 227–30.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Sone D, Ota M, Yokoyama K, Sumida K, Kimura Y, Imabayashi E, Matsuda H, Sato N. Noninvasive evaluation of the correlation between regional cerebral blood flow and intraventricular brain temperature in temporal lobe epilepsy. Magn Reson Imaging. 2016;34(4):451–4.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Stevens RD, Shoykhet M, Cadena R. Emergency neurological life support: intracranial hypertension and herniation. Neurocrit Care. 2015;23(S2):76–82.CrossRefGoogle Scholar
  61. 61.
    Tarnal V, Vlisides PE, Mashour GA. The neurobiology of anesthetic emergence. J Neurosurg Anesthesiol. 2016;28(3):250.PubMedPubMedCentralGoogle Scholar
  62. 62.
    van der Veen PH, Muller M, Vincken KL, Westerink J, Mali WP, van der Graaf Y, Geerlings MI, SMART Study Group. Hemoglobin, hematocrit, and changes in cerebral blood flow: the Second Manifestations of ARTerial disease-Magnetic Resonance study. Neurobiol Aging. 2015;36(3):1417–23.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Vestergaard MB, Lindberg U, Aachmann-Andersen NJ, Lisbjerg K, Christensen SJ, Law I, Rasmussen P, Olsen NV, Larsson HB. Acute hypoxia increases the cerebral metabolic rate – a magnetic resonance imaging study. J Cereb Blood Flow Metab. 2016;36(6):1046–58.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Villanueva-Meyer JE, Mabray MC, Cha S. Current clinical brain tumor imaging. Neurosurgery. 2017;81(3):397–415.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Whittaker JR, Driver ID, Bright MG, Murphy K. The absolute CBF response to activation is preserved during elevated perfusion: implications for neurovascular coupling measures. NeuroImage. 2016;125:198–207.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Wu J, Li W. Predictors of seizures after lateral skull base tumor resection: a retrospective study. J Public Health Policy Plan. 2017;1(2):21–4.Google Scholar
  67. 67.
    Yano S, Hide T, Shinojima N. Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas. World Neurosurg. 2017;99:533–42.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Yeoh TY, Tan A, Manninen P, Chan VWS, Venkatraghavan L. Effect of different surgical positions on the cerebral venous drainage: a pilot study using healthy volunteers. Anaesthesia. 2016;71(7): 806–13.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Yuan Q, Wu X, Yu J, Sun Y, Li Z, Du Z, Mao Y, Zhou L, Hu J. Effects and clinical characteristics of intracranial pressure monitoring-targeted management for subsets of traumatic brain injury: an observational multicenter study. Crit Care Med. 2015;43(7): 1405–14.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Garry Brydges
    • 1
    • 3
    Email author
  • Ninotchka Brydges
    • 2
  • Charles Cowles
    • 3
  1. 1.Anesthesiology – CRNA SupportThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Division of Anesthesia, Critical Care and Pain Medicine, Department of AnesthesiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations