GENERAL INFORMATION
The skull consists of bones and ligaments which form the face and the cranial fossa that encompasses the brain. The bones that form the skull base also form the eye orbits, the roof of the nasal cavity and part of the paranasal sinuses. In addition, some of these bones surround the area of the ear. The skull base is an anatomically complex and crowded area. It has many cavities (openings) through which the spinal cord, cranial nerves and various vessels for brain perfusion pass by.
Paranasal Sinus and Skull Base Surgery is used to remove benign or neoplastic lesions, as well as treat congenital anomalies of the nervous system located on the lower surface of the brain, the paranasal sinus area, the skull base and the upper part of the spine.
Sometimes, the skull base area cannot be approached with conventional surgery. In these cases, applying minimally invasive methods, such as endoscopy, may assist significantly. When the endoscopic method is used, the tools necessary for the surgery are introduced through the natural openings of the skull, such as the nose and mouth, or through small holes directly above the eyebrow.
This type of surgery requires close collaboration among a team of various specialists (neurosurgeons, ENT specialists, radiologists). Before the advent of Paranasal Sinus and Skull Base Surgery, the only way to remove lesions in this area was the conventional way, through craniotomy. Note, however, that is some cases, this method may still be used today.
SERVICES
Our Center offers the entire range of advanced surgical procedures to treat lesions in the areas of the paranasal sinuses and the skull base. We provide renewed hope and improve the quality of life of patients suffering from hard-to-approach lesions that had previously been considered untreatable.
Our medical team reviews your case and comes up with a team decision as to the best treatment for you.
There are 3 treatment options available:
- Watchful waiting
- Surgery
- Stereotactic radiosurgery
Watchful waiting is usually followed for small lesions in patients without symptoms. It involves clinical and imaging (brain MRI) monitoring and is carried out at regular intervals, to verify or rule out an increase in the lesion over time.
Surgery may be performed in 2 ways: endoscopically or conventionally (open). Although the surgery of choice is endoscopic, the conventional (open) method may be required in some cases, depending on the location, size and nature of the lesion.
The endoscopic method is minimally invasive and does not require large incisions. The tools necessary to remove the lesion are inserted through natural openings or very small incisions. The simultaneous use of neuronavigation assists significantly in the more effective and safer removal of the lesion.
The conventional or open method requires larger incisions in the area of the face or the skull. Part of the bone is removed to better approach the lesion. The surgical removal involves the use of microsurgery tools under microscope.
Stereotactic radiosurgery is a non-invasive radiotherapy technique that aims to treat lesions located in hard-to-reach areas, such as the skull base. Its main feature is its great accuracy (1-2 mm). It can be used right from the start for small lesions or as complementary therapy for small residual lesions following surgery.
MEDICAL INFRASTRUCTURE & TECHNOLOGY
The Paranasal Sinus and Skull Base Surgery Department is supported by the most advanced, state-of-the-art neurodiagnostic imaging on this part of the anatomy, as well as fully trained medical staff.
The main diagnostic tools used to investigate and treat lesions found in this area are brain MRI, brain CT, bone scan, endoscopy, angiography, neurophysiology monitoring and neuronavigation.
- The brain MRI is a diagnostic tool that offers high-resolution 3D imaging of the lesions located in this area.
- The brain CT provides useful information about the pathology of bone structures in relation to lesions located in the sinuses and skull base.
- The bone scan or scintigraphy is an excellent exam for tracking bone lesions, while it can also indicate whether the lesion has spread to other human body organs.
- Endoscopy is a modern diagnostic and therapeutic tool in modern neurosurgery and otolaryngology. It provides 3D imaging of the lesions and significantly improves depth perception when surgically excising a lesion.
- Angiography traces significant vascular structures in the sinuses and skull base. Preoperative identification of vessels assists in protecting them, therefore, minimizing blood loss during surgery.
- Cranial nerve monitoring during surgery is used to identify and protect the nerves, ultimately aiming to preserve the sense of smell, vision, hearing, speech, swallowing and other basic functions of the human body.
- Neuronavigation is a groundbreaking intraoperative imaging system that is used to identify the precise location of the lesion and its relation to key surrounding neurovascular structures during surgery.
FAQs
The conditions include pituitary adenomas, skull base meningiomas, craniopharyngiomas, chordomas (which are lesions that develop slowly in the skull base), trigeminal neuralgia, glossopharyngeal neuralgia, cerebrospinal fluid rhinorrhea, vascular anomalies, nasal turbinate hypertrophy, sinusitis, nasal and paranasal tumors.
There are two methods: endoscopic and conventional (open). Although the surgery of choice is endoscopic, the conventional (open) method may be required in some cases, depending on the location, size and nature of the lesion.
The endoscopic method is minimally invasive and does not require large incisions. The tools necessary to remove the lesion are inserted through natural openings or very small incisions. The simultaneous use of neuronavigation assists significantly in the more effective and safer removal of the lesion.
The conventional or open method requires larger incisions in the area of the face or the skull. Part of the bone is removed to better approach the lesion. The surgical removal involves the use of microsurgery tools under microscope.
The symptoms patients exhibit depend on the nature, size and position of the lesion. They may include: pain on the face, headache, dizziness, vision impairment, numbness, hearing impairment, difficulty breathing, nasal congestion, gait disorders and memory problems.
The diagnosis of paranasal and skull base lesions is initially based on the symptoms and the physical examination.
Because this area it not visualized easily, other tests are also required to complete the diagnosis. These include imaging scans of the brain and head (CT, MRI, MRA, etc.), as well as tests to examine the muscles, nerves, vision and hearing.
Apart from the endoscopic or conventional (open) method used to remove the lesion, other treatments may also be needed, depending on the nature of the excised lesion. These may include chemotherapy, radiation and stereotactic radiosurgery.
Immediately after surgical excision of a lesion, patients are closely monitored by our medical team. The aim is the safe discharge of all patients and their quick return to their daily activities. In some cases, and depending on the nature of the excised lesion, certain patients may need to follow other treatments, such as radiation, chemotherapy or physical therapy. Many of these must also be closely monitored with imaging scans to rule out any relapse of the operated lesion in the future. Lastly, given that some surgical procedures in the paranasal sinuses and skull base are quite painful and stressful for patients, the support of friends and family is important.
