Current Concepts in the Management of Tumors of the Skull Base

Abstract

Background: Due to their involvement with critical neurovascular structures, tumors located in the cranial base present challenges to neurosurgeons and are associated with high morbidity and mortality. Methods: Rates of tumor control, complications, patient outcomes, and recurrences were extracted and summarized from two decades of our surgical and radiological treatment follow-up and review of the medical literature. Results: Recent advances in surgical techniques involving cranial base approaches have made surgical intervention safer and curative resection more likely. In managing benign tumors, surgical resection is the gold standard for treatment. While immediate complications are still significant, long-term outcomes in most cases are excellent. Focused radiosurgery using a gamma knife or linear accelerator has produced favorable outcomes, and it improves the management of small or minimally symptomatic cranial base tumors. For slow-growing malignant tumors, extensive surgery followed by radiotherapy achieves the best outcome. In managing highly malignant tumors, outcome is determined by the effects of chemotherapy and radiotherapy. On some occasions, surgery is needed to obtain greater control of highly malignant tumors. Conclusions: Skull base tumors are relatively common, and management of these tumors is rapidly evolving. The combination of surgical excision using cranial base techniques, radiosurgery, fractionated radiotherapy, and chemotherapy should be individually tailored based on the location and pathological aggressiveness of the tumor and the symptomatology of the patient. Appreciation is expressed to Jennifer Pryll for her illustrative and photographic assistance and to Joseph Reister for editing and preparing the manuscript.