The skull base surgery program offers many treatment options to accomplish dual goals: to treat the patient's condition, and to achieve the highest quality of life. These treatments range from open procedures for more involved diseases, advanced minimally invasive endoscopic procedures, and non-invasive options, sometimes in combination, and all tailored to the patient's disease and treatment needs.
With so many options available, and many different diseases treated, each patient's treatment plan is customized based on a number of factors. This includes the location of the affected area or areas, the stage of the disease, and the person's age and general health. The team spends time with patients to discuss every step of the process, from workup, to treatment, and follow-up.
Because of the complexity of caring for these types of problems and wanting multi-disciplinary team input to offer patients the most comprehensive yet understandable options, the team meets to discuss each individual case in regular Head and Neck/Skull Base and Pituitary Multi-Disciplinary Conferences.
In some cases, observation is most warranted. For certain types of diseases, treatment may not be immediately necessary unless there are concerning symptoms or changes seen on examination or diagnostic testing. Appropriate monitoring of symptoms and the size, shape, and location of a patient's tumor, as well as quality of life assessments can all be a part of this process and in determining an individual's best course of care.
The surgical team will work to remove the diseased tissue, while preserving surrounding healthy tissue. If the patient has a very large or complex tumor, the procedure may involve a team of two or more specialists operating at the same time. Sometimes radiation, chemotherapy, or both are used in addition to surgery. Some tumors are better treated with surgery first, while others may be better treated with surgery after other therapies. Options include:
Skull Base Surgery (Open Procedure)
BMC's skull base surgery team are experienced in doing what is called an "open procedure." This is a procedure by which tumors are removed using very carefully placed incisions along the face and/or skull to remove a tumor. This type of surgery often has good functional and cosmetic outcomes. Recovery time from open procedures are longer than with an endoscopic approach.
Minimally Invasive Surgery
Skilled in performing traditional, open craniotomies, BMC's surgical team also excels at endoscopic, minimally invasive skull base surgery. Some of the innovations in this type of surgery and studies looking at their effectiveness were pioneered at BMC.
Endoscopic Skull Base Surgery
This is a type of skull base surgery that either doesn’t require any incisions, or, uses much smaller, hidden incisions than one would need for an open procedure to treat the same type of tumor. Using endoscopes (small cameras that see deep into the body), and special instruments designed for this type of surgery, tumors can be removed. In most cases, entry through the nostrils is enough to perform this delicate, complex surgery. Both cancerous and non-cancerous tumors can be removed in this way. This reduces recovery time as well as the length of time spent in the hospital, and gets a person back to their normal life very quickly. Not every patient is a candidate for endoscopic skull base surgery, but many patients benefit from this advanced surgical method.
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment to cure the tumor or in combination with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.
Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.
CyberKnife delivers highly targeted beams of radiation directly into tumors, in a pain-free, non-surgical way. Guided by specialized imaging software, we can track and continually adjust treatment at any point in the body, and without the need for the head frames and other equipment that are needed for some other forms of radiosurgery.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, it destroys cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type of condition, may receive palliative care. It works best when palliative care is started as early as needed in the treatment process, as it can be an integral part of a patient's overall care plan to treat and alleviate symptoms and side effects.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. They are designed to treat the patient's physical, emotional, and social needs.