There are many diseases that affect the skull base, including benign (non-cancerous) tumors, cancerous tumors and infectious/inflammatory diseases. We can help identify your skull base condition and work with you to determine which treatment(s) will be best for your unique needs.
Benign (Non-Cancerous) Tumors
Benign tumors are not cancerous, meaning they don’t spread to other parts of the body. When these non-cancerous tumors grow in or around the skull base, they can push on important nerves and cause symptoms, including vision loss, or produce chemicals (hormones) that can create a variety of health problems.
The pituitary gland, located beneath the brain, directly under the vision nerves and behind the nasal sinuses, is considered the body’s “master gland” because it controls the function of many other hormone-producing glands. Pituitary adenomas are tumors (usually slow growing) arising from the pituitary gland. Because of their location next to optic nerves, they can press on these nerves and cause vision loss.
Some pituitary adenomas release hormones that cause conditions such as weight gain, high blood sugar and bone problems (due to extra steroid hormones). Alternatively, pituitary adenomas can also prevent the pituitary gland from producing normal hormones. Typically, pituitary adenomas are treated with minimally invasive endonasal surgery to remove the adenoma, though some are treated with radiation or medication. Learn more about pituitary and neuroendocrine disorders.
Angiofibromas are benign, slow-growing vascular tumors that typically cause blockage of one nostril as well as frequent nose bleeds. Angiofibromas are most common in young men and can be treated with minimally invasive procedures that can completely remove the tumor, effectively removing the nasal blockage.
Schwannomas are benign, slow-growing tumors that arise from the supporting cells around the nerves leaving the brain and spinal cord. Within the skull base, schwannomas most commonly grow from the nerve that controls balance (vestibular nerve). Because the balance nerve travels alongside the hearing nerve in the inner ear canal, these tumors can press on the hearing nerve and impair hearing on one side, cause ringing in the ear, and dizziness or vertigo.
The facial nerve (which controls facial movement) and brainstem (which transmits information from the brain to the body and back) are also nearby, so larger vestibular schwannomas may cause facial numbness or weakness, body tingling, imbalance or headaches. Patients with neurofibromatosis type 2, a rare inherited disease, often develop vestibular schwannomas on both sides of the head.
Vestibular schwannomas may be treated with surgery, radiation (stereotactic radiosurgery), or a combination of both. Surgery is often performed collaboratively between ear surgeons (otologists/neurotologists) and a neurosurgeon. Since these tumors are slow growing, doctors may monitor them with imaging before treatment is needed.
Meningiomas grow from the surface coverings of the brain called the meninges. Most are benign, but some can behave more aggressively and grow faster, or recur after treatment. They typically grow outside of the brain and can compress the brain or spinal cord tissue, causing headaches, seizures and loss of smell or vision.
Meningiomas that grow under the brain (along the skull base) require special techniques and a skull-base team approach to be surgically removed. The specific approach must be tailored to the location of the tumor and the important structures nearby. Meningiomas can be treated with surgery, including minimally invasive procedures, or radiation (stereotactic radiosurgery).
Paragangliomas develop in different parts of the skull base and are named by their location, including the glomus jugulare, glomus tympanicum, and glomus vagale. Symptoms associated with paragangliomas depend on their location but can include ringing or pulsing in the ears, hearing loss, dizziness/imbalance, headaches, trouble swallowing, trouble speaking or difficulty moving the tongue. In rare cases, paragangliomas secrete hormones that cause uncontrollable high blood pressure. Paragangliomas are typically treated with radiation (radiotherapy or stereotactic radiation).
Cholesteatomas are skin growths that occur behind the eardrum, inside the middle ear. Symptoms include a feeling of fullness in the ear and hearing loss. Cholestestomas can be treated with surgery. Learn more about cholestaetoma treatments.
Osteomas are the most common tumor found in the nose and sinus cavity. While osteomas are often asymptomatic, you can experience headaches, sinus pressure and frequent sinus infections. If your osteoma is causing sinus blockage and/or symptoms, it can be removed with minimally invasive surgical procedures.
Epidermoid cysts are clusters of epithelial cells (skin or hair cells) that get trapped in the areas inside or adjacent to the brain during development. These benign growths can become infected over time, and may lead to swelling over the bridge of the nose or forehead. Epidermoids are usually treated with surgical removal, and surgery may be minimally invasive depending on the size and location of the cyst.
Pleomorphic adenomas, or benign mixed tumors, are one of the most common tumors that arise in the parotid gland, a salivary gland located in the cheek. When the tumors develop in the skull base, we typically treat them with surgery through a small incision behind the jawline.
Cranial orbital fasciitis is a rare benign, tumor-like overgrowth in bone around the eye or skull base. We usually treat cranial orbital fasciitis with surgery.
Skull base osteomyelitis is a severe infection caused by bacteria that grows in the bones behind the nasal and sinus cavities or inner ear. Surgery is used to clear the infected tissues and obtain cultures to accurately diagnose and treat the osteomyelitis.
Solitary fibrous tumors (formerly called hemangiopericytomas) are tumors arising from cells that support and surround the blood vessels. They can look similar to meningiomas (above) but tend to involve more blood vessels and are more likely to recur even after complete removal. They vary from benign to malignant. For more aggressive tumors, surgery is often followed by additional treatment, such as radiation therapy.
Malignant tumors, or cancers, occur when cells grow quickly and uncontrollably. Malignant tumors grow faster than benign tumors and can affect structures near their original growth site. They can spread (metastasize) to other areas of the body if left untreated. Treatment for these tumors tends to be more aggressive than for benign tumors, often combining surgery, radiation and medical treatment from a multidisciplinary team of physicians.
Squamous cell carcinoma is a cancer that begins in the uppermost layers of the skin or nasal lining and is usually a result of lifelong sun exposure. Squamous cell carcinomas affecting the skull base often grow in the lining of the nose, sinuses and ear canal. Symptoms can include blockage of the nose, nasal drainage, nose bleeds, loss of smell, change in taste and sometimes changes in vision (such as double vision). Treatment usually involves a combination of surgery, radiation and/or chemotherapy.
Adenocarcinoma is a cancer found in glandular cells that produce mucus. In the skull base region, adenocarcinomas commonly form in the sinus cavities between and under the eyes. Wood workers and people with long-lasting exposure to wood and sawdust may have an increased risk of developing sinus or nasal adenocarcinoma. Symptoms may include nasal blockage, nasal drainage, nose bleeds and vision changes (double or clouded vision). Adenocarcinomas are treated with a combination of surgery, radiation and/or chemotherapy.
Esthesioneuroblastomas, which grow at the roof of the nasal sinuses under the front of the brain, occur near the nerves responsible for the sense of smell. These tumors can occur in the upper nasal cavity (above your nose, between your eyes) as well as the portion of the brain that sits above the nose . As the tumor grows, its symptoms can include nasal blockage, nosebleeds, loss of smell, vision problems (double or clouded vision) or headaches. Treatment involves minimally invasive surgery through the nose to remove it completely, followed by radiation therapy with or without chemotherapy.
Adenoid cystic carcinoma is an aggressive cancer that occurs in saliva glands located in the head and neck. Depending on the tumor’s location, it can cause vision problems, such as double vision or blurry vision that affects only one eye. Patients may also experience sharp pain in the face, specifically the forehead, cheek or jaw, and can be associated with numbness and tingling. Treatment may include surgery, radiation and/or chemotherapy.
Chordomas are found on the spine or the skull base. Symptoms of chordomas can include double vision, difficulty swallowing or moving of the tongue, and sensory changes such as vision loss or facial numbing. As the chordomas grow, they can also lead to brain stem compression, which causes weakness in the arms and legs. The primary treatment for chordomas is surgery to remove the tumor, followed by radiation.
Chondrosarcomas are usually slow-growing tumors that occur along places where bones connect in the skull base. Symptoms include hearing and vision problems and facial pain, and treatment usually consists of surgery, which may be followed by radiation in some cases.
Mucoepidermoid carcinomas are cancerous growths that arise in the salivary glands. Symptoms depend on the location of the tumor, but may include facial swelling, facial pain, facial asymmetry and facial numbness/tingling. Treatment typically consists of surgery followed by radiation.
Osteosarcoma is a cancer of the bone. While it is more common in arm or leg bones, facial or skull bones can be affected. Treatment is dependent on the location of the tumor and may involve surgery, radiation and/or chemotherapy.
Rhabdomyosarcoma is a rare cancer in muscle tissue, and it can grow in muscle tissue at the skull base or in the eye socket. Treatment is dependent on the location of the tumor and may involve surgery, radiation and/or chemotherapy.
Neuroendocrine carcinoma is a cancer that grows from nerve or hormone-secreting cells. While these tumors can occur in other areas of the body, for skull base tumors, neuroendocrine carcinomas develop in tissues high in the nose. Common symptoms include changes in your sense of smell, nasal blockage, nasal drainage and headaches. Treating nasal and skull base neuroendocrine tumors requires a truly multidisciplinary approach that often includes surgery, chemotherapy and radiation therapy.
These are aggressive tumors in the nasal cavity and sinuses, and symptoms include nasal blockage on one side, bloody nasal drainage, facial pain and pressure. For treatment, chemotherapy and radiation as well as surgery may be recommended. In select cases, surgery can be performed with minimally invasive approaches through the nose.
This is a rare form of the malignant skin cancer melanoma. Rather than developing in skin cells, mucosal melanoma grows in melanin-producing cells inside the lining of the nose and sinuses. Treatment includes immunotherapy, chemotherapy and in some cases, surgery.
Basal cell carcinoma is a common form of skin cancer. It may present as a painless growth or wound on the skin that does not heal. When it grows in or around the skull base, a multidisciplinary skull base team can remove the carcinoma with surgery. Additional treatment with radiation and/or chemotherapy is often used after surgery.
Congenital and Other Acquired Conditions
Some people are born with variations in their skull base bones that can lead to compression of the brain, spinal cord and nerves for vision, smell, hearing and balance. Gaps in the bone may also lead to leakage of fluid from the brain into the nose or ear. Common congenital skull base conditions caused by these variations include:
Encephaloceles are deformities that occur when the brain and dura (the thick membrane that surrounds the brain and spinal cord) slip through a hole in the skull bone. Encephaloceles vary in size and location, and may be associated with cerebrospinal fluid leakage or seizures. They are typically treated with minimally invasive surgery through the nose and ear to repair the hole and prevent cerebrospinal fluid leakage.
Cerebrospinal fluid leaks happen when the clear fluid that surrounds your brain and spinal cord escapes out of your nose or ear. Symptoms for cerebrospinal fluid leaks include steady, consistent, clear drainage from one nostril or ear. Patients may also experience headaches, nausea or vomiting. As the fluid seeps out, bacteria can enter the sterile brain space, which can lead to meningitis, a potentially life-threatening disease. Treatment of cerebrospinal fluid leaks consists of surgery to patch the hole(s) through which the fluid is leaking, then covering it with healthy tissue.
Arachnoid cysts are fluid-filled pockets in and around the brain. Though most arachnoids cysts do not cause symptoms, they may cause headaches, hearing and vision problems or dizziness. Arachnoid cysts do not usually require treatment unless symptoms are present or the cyst is growing. In these situations, surgery is performed to drain the cyst or poke holes in it to allow the fluid to be absorbed around the brain (called fenestration).
The semicircular canals are the balance organs of the inner ear and are normally covered in thick bone. Superior semicircular canal dehiscence (SSCD) is caused by an abnormal opening or thinning of the bone that allows pressure to be transmitted between the inner ear and the brain. Common SSCD symptoms include vertigo or dizziness (which may be provoked by loud sounds or pressure) and hearing loss. Patients may also experience oscillopsia (the sensation that objects are moving when they are not) and autophony (hearing your heartbeat and other body sounds very loudly). Treatments for SSCD include surgery to plug or cover the hole, which may involve going above or behind the ear.
The tegmen tympani is another name for the bony roof of the middle ear, which doubles as part of the base of the skull. With tegmen tympani dehiscence, the bone has thinned to the point of causing either an encephalocele or a cerebrospinal fluid leak into the ear. Symptoms include hearing loss, ringing in the ears, dizziness and headaches. If an encephalocele or cerebrospinal fluid leak is present, patients may experience seizures, meningitis or a sensation of fluid in the ear that can leak down to the nose. To treat tegmen tympani dehiscence, our surgeons repair the gap in the bone using nearby healthy tissue to prevent further leakage of fluid.
When a blood vessel pushes against nerves in the skull base, it’s called cranial nerve vascular compression. Common symptoms associated with cranial nerve vascular compression include pain in the face or muscle spasms on one side of the face. Depending on your specific condition, we may recommend medication, stereotactic radiosurgery or surgery to relieve compression of the nerve.
Facial fractures occur when the bones of the nose, face and eye sockets are broken after trauma. Symptoms usually include facial swelling, bruising and nose bleeds. Vision changes or double vision can be caused by fractures of the bones around the eye sockets.
The temporal bone is important because it houses the organs for hearing and balance as well as the nerve that helps control facial expression. Temporal bone fractures can result in hearing loss or in rare cases, facial weakness. They are usually managed without surgery and often heal well on their own. In cases where facial weakness has occurred, surgery might be necessary to help with facial expression. Surgery can also be performed later to help with hearing loss associated with temporal bone fractures.
Weakness or paralysis of the face can be distressing for patients. One side of the face is usually affected. Causes include trauma to the facial nerve, infections or inflammation that result in nerve swelling, certain tumors or growths that compress the nerve, or surgery. Imaging studies and nerve conduction tests can help doctors give a prognosis for recovery. Certain medications, if given early, may help the facial nerve recover, so it’s important for patients to receive a timely evaluation. Surgical procedures can restore some function and symmetry to the face and may involve nerve grafting or re-adjusting facial muscles and tissue.
Basilar invagination and craniocervical instability are conditions either present at birth or acquired through trauma. They occur when the second vertebra of the spine is positioned incorrectly and ends up pressing on the brainstem. They can lead to numbness and tingling in the extremities, difficulty swallowing and headaches; symptoms may worsen when bending the neck. Minimally invasive surgery can be performed to relieve the pressure and improve the stability of the vertebrae.
Mastoiditis is a severe ear infection in the mastoid bone behind the ear. Though mastoiditis is commonly treated using antibiotics, extreme cases may require the infected bone to be removed (mastoidectomy) or a tube to be placed in the eardrum to help drain the infection.
Fungal sinusitis has many forms. Some patients may experience a build-up of fungus in one of the sinuses that can lead to an infection. In these cases, we can perform endoscopic sinus surgery to remove the fungal debris. Patients with underlying conditions affecting the immune system may experience more severe fungal infections of the nose and sinuses. These patients may require surgery to remove the affected tissue as well as antifungal antibiotics by IV.
Fibrous dysplasia is a disease people are born with in which fibrous tissue replaces bone. While it’s more common in arm or leg bones, skull base fibrous dysplasia can cause headaches, facial pain and vision changes. Minimally invasive surgery can be performed to remove affected bone and to alleviate pressure on the surrounding structures, such as the brain or eye.