Endoscopic Skull Base Surgery
Why is this surgery done?
The goal of any brain surgery is to treat the problem without damaging the delicate brain or nerves around it. Sometimes the best way to get to problems on the underside of the brain is from below. This often gives a much safer path to the problem that avoids pulling or moving sensitive parts of the brain sitting on top of the diseased area. The most common conditions treated this way are:
How is endoscopic skull base surgery done?
In most cases, the surgery is done through both nostrils at the same time, with an ear, nose and throat (ENT) surgeon and a neurosurgeon working together. No cuts are made on the outside of the face or head. A long, thin camera is inserted in one side of the nose, and surgical instruments are inserted in both. The air sinuses in the back of the nose are opened up to create space underneath the base of the skull. A hole is made in the base of the skull at the back of the nose, and the tumor or problem is then removed/treated through that hole while looking at a screen showing what the camera is seeing. The hole is then closed in one of a variety of ways. Sometimes a very small cut is made on the belly to get a plug of fat to seal off the hole at the end of surgery, and sometimes a temporary drain is placed in the lower back to drain spinal fluid during and after surgery.
What are my risks? What are common complications?
Any surgery on or around the brain has risks. Some of the more common risks of this procedure are:
- Discomfort or sinus difficulties from working through the nose
- Leakage of spinal fluid from the surgery that may need other procedures to repair
- Regrowth or return of the problem in the future
Other risks are unique to your problem and could involve the nerves to your eyes, the hormones made by the pituitary gland or the blood vessels to the brain. Your doctor will discuss these with you.
What do I need to know before surgery?
You should be off of any blood thinning medication for this surgery. Smoking and alcohol use should be stopped before surgery. You may need appointments for medical clearance or to get special imaging studies before your surgery. If you are having any sinus or nose problems before surgery, such as an infection or a cold, it may be better for that to be treated first depending on the urgency of your surgery.
General discharge instructions
In most cases the patient will spend the first night in the neurosurgical intensive care unit to watch for any neurological changes and keep blood pressure well controlled. Time in the hospital after surgery depends on a number of factors, such as:
- Any signs of a spinal fluid leak after surgery
- Changes in the hormone production of the pituitary gland
- Need for spinal fluid drainage from a drain for a period of time after surgery
Some patients are able to go home 1 – 3 days after surgery, while others may be in the hospital longer for a variety of reasons that your doctor will discuss with you.
It is very important after this surgery to protect the back of your nose to prevent a spinal fluid leak or a healing problem. Special precautions include:
- Avoiding coughing or sneezing, and doing so through an open mouth if you must
- Avoiding nose blowing
- Avoid drinking through straws
- Avoid straining, heavy lifting or constipation
These will generally continue for a few weeks to a few months after surgery, depending on what was done.
What should I expect while recovering?
Some pain, pressure and a blocked nose sensation are common after this surgery and improve with time. There may be occasional spotting or drainage from your nose as the surgery heals, but this will stop; ongoing drainage should be reported to your doctor. You may need to see a hormone doctor (an endocrinologist) and/or an eye doctor (an ophthalmologist) after you leave the hospital to help with any healing related to those areas, depending on your surgery.