Skull Base Surgery in Indore

What is skull base surgery?

The skull base is the bony floor on which the brain rests. It sits behind the eyes and nose and above the ears and neck. Many important nerves pass through it, including the nerves for sight, smell, hearing, facial movement and swallowing, along with major blood vessels.

Tumours in this area include meningiomas, acoustic neuromas (also called vestibular schwannomas, growths on the hearing and balance nerve), pituitary tumours, craniopharyngiomas and chordomas. Most are not cancer, but they can cause problems by pressing on nerves or the brain.

Depending on where the tumour is, the surgeon may reach it through the nose using an endoscope (endoscopic endonasal approach), or through an opening in the skull using a microscope (microscopic approach). Some operations combine both, and an ENT (ear, nose and throat) surgeon may be part of the team.

Who may need it

People with a skull base tumour that is causing symptoms, such as loss of vision, double vision, hearing loss, facial numbness or weakness, or difficulty swallowing.

People with a tumour that is growing on repeat MRI scans.

People with a leak of brain fluid through the nose (CSF leak) from a defect in the skull base.

People who need a tissue diagnosis to plan further treatment.

Some small, slow-growing tumours can be watched with regular scans, or treated with focused radiation instead of surgery. The choice depends on the tumour, your age, your symptoms and your general health.

Surgery is one option, not the only one. It is decided after an examination and a careful look at your scans, and non-surgical treatment is discussed first where it is suitable.

How it is done

1
Detailed MRI and CT scans are studied to plan the safest route. Some patients need eye, hearing or hormone tests first.
2
You are given general anaesthesia and are fully asleep.
3
In the endoscopic approach, the surgeon passes a thin camera and tools through the nostrils to reach the tumour, with no cut on the face. In the microscopic approach, a small opening is made in the skull, often behind the ear or near the hairline.
4
The tumour is carefully separated from nerves and blood vessels and removed as far as is safe. Sometimes a part is left on purpose to protect important structures, and treated later if needed.
5
The opening in the skull base is repaired, sometimes using a flap of tissue from inside the nose or a small graft, to prevent a CSF leak.
6
You are watched closely in the ICU (intensive care unit) after the operation.

Possible risks

Every operation carries some risk. Your surgeon will explain which of these apply to you.

CSF leak (leak of brain fluid), often seen as clear watery drip from the nose. It may need bed rest, a drain or another operation.

Injury to nerves, which can cause hearing loss, facial weakness, double vision, numbness, or difficulty swallowing or speaking. Some of these may be permanent.

Bleeding, including injury to a major blood vessel, which is rare but serious, and stroke.

Infection, including meningitis (infection of the brain covering).

Hormone problems if the pituitary gland is affected, and loss of smell or nasal crusting after surgery through the nose.

The tumour may not be fully removed, or may grow back, and need further treatment. Anaesthesia also carries its own risks.

Preparing for surgery

Bring all MRI and CT scans on films or CDs, and all previous reports.

You may need eye tests (vision and field of vision), a hearing test, and hormone blood tests, depending on where the tumour is.

Blood tests, an ECG (heart tracing) and a check-up with the anaesthetist are usually done.

If you take blood thinners, stop them only when and as your doctor advises. Tell the team about all other medicines.

Follow the fasting instructions given by the hospital.

Plan for a hospital stay of several days and arrange for a family member to stay with you, especially if you are travelling from outside Indore.

Recovery

After surgery, patients usually spend a day or more in the ICU. The total hospital stay is often about 5 to 10 days, and sometimes longer, depending on the operation and recovery.

After surgery through the nose, avoid blowing your nose, straining, lifting heavy weights and bending forward for some weeks, as advised. Report any clear watery drip from the nose, severe headache or fever at once.

Some nerve problems improve slowly over months. Physiotherapy, speech and swallowing therapy, or eye care may be needed. Regular MRI scans are usually advised to check for any regrowth.

Questions patients ask

Will there be a scar on my face?

When the surgery is done through the nose with an endoscope, there is no cut on the face. When an opening in the skull is needed, the cut is usually placed behind the ear or within the hairline.

Is endoscopic surgery always better than open surgery for the skull base?

No. Each approach suits different tumour positions. Some tumours are easier and safer to reach through the nose, others through the skull, and some need both. The surgeon chooses the route that gives the safest access to your tumour.

Can I avoid surgery?

Sometimes. Small tumours that are not growing or causing symptoms may be watched with MRI scans. Some can be treated with focused radiation. Your surgeon will explain whether these options suit you.

How long will I stay in hospital?

Often about 5 to 10 days, including a stay in the ICU. It may be longer for larger operations or if there are complications.

Will my hearing or vision come back after surgery?

It depends on how long and how badly the nerve was pressed before surgery. Vision often improves when pressure on the optic nerve is relieved early, but hearing that is already lost often does not return. Your surgeon will discuss what to expect in your case.

Disclaimer: This information is for general awareness and is not a substitute for a medical consultation. Read moreSource: Content on this website was prepared with the help of AI tools (AI-assisted) and is medically reviewed by Dr. Kshitiz Nigam, MBBS, MS, MCh (Neurosurgery), Reg. No. MP-33282.