If you or someone in your family has been told you have a tumor or other problem at the skull base, this page explains what that means, what the symptoms are, and how it is treated at UPMC. To request an evaluation or a second opinion, call 412-647-3685.
What Is the Skull Base?
The skull base is the floor of the skull. It is the bony platform that separates the brain above from the nose, sinuses, eyes, and ears below. Almost every nerve that controls vision, hearing, facial movement, and swallowing passes through it, along with the major arteries that supply blood to the brain.
Because so much is packed into a small space, a growth here can press on structures that matter a great deal, even when the growth itself is small and not cancerous.
What Is Skull Base Surgery?
Skull base surgery is the treatment of tumors, cysts, and other lesions in this region. The goal is not only to remove the problem but to protect the nerves and blood vessels around it, so that your vision, hearing, facial movement, and hormone function are preserved.
Most skull base tumors are benign, meaning they are not cancer. Some can be watched. Some are treated with medication. Some are removed through the nose without an incision. Which path is right depends on what the lesion is, where it sits, and how it is affecting you.
Symptoms to Watch For
Skull base problems are often found because of symptoms that seem unrelated to the brain:
- Blurred vision, double vision, or loss of side vision
- Hearing loss in one ear, ringing in the ear, or trouble with balance
- Numbness, weakness, or pain in the face
- Hoarseness, a weak voice, or trouble swallowing
- Hormone changes such as fatigue, unexplained weight change, or irregular menstrual cycles
- Clear fluid draining from the nose, which can mean a leak of spinal fluid
- Nasal blockage, loss of smell, or sinus infections that keep coming back
- Headaches, especially alongside any of the symptoms above
Each of these has common and harmless causes. They are worth asking a doctor about when they persist or get worse.
Conditions Treated Here
Our team treats adults and children with:
- Pituitary tumors and Rathke's cleft cysts
- Meningiomas
- Acoustic neuromas and other schwannomas
- Craniopharyngiomas
- Chordomas and chondrosarcomas
- Sinus and nasal cavity tumors, including olfactory neuroblastoma
- Cysts, encephaloceles, and other conditions present from birth
- Spinal fluid leaks and skull base fractures
- Aneurysms and other blood vessel problems at the skull base
- Infections and inflammation involving the skull base
See the full list of conditions we treat »
How Skull Base Problems Are Treated
Watching and waiting
Small tumors that are not causing symptoms are often followed with periodic MRI scans rather than treated right away. Many never need surgery, and treatment is considered if the tumor grows or begins to cause symptoms.
Medication
Certain pituitary tumors shrink with medication. If you have one of these, you may be treated by an endocrinologist without an operation.
Surgery through the nose
The endoscopic endonasal approach, or EEA, was developed at UPMC. The surgeon reaches the skull base through the nostrils using a thin camera and instruments, so there is no incision and no need to open the skull. A small opening is made in the bone at the base of the skull to reach the tumor directly, without moving the brain. Compared with open surgery, patients generally have less scarring, fewer complications, and a faster recovery. Learn more about EEA »
Read common questions and answers about EEA »
Small-opening surgery near the eye or behind the ear
Some tumors are best reached through a small opening at the eye socket or behind the ear. These operations are shorter than traditional surgery and can help protect hearing and vision.
Open surgery
Larger or more complicated tumors may need a traditional operation in which a section of the skull is temporarily opened. Sometimes an open operation and a procedure through the nose are combined, either in one surgery or in stages. Learn more about open approaches »
Gamma Knife radiosurgery
Despite the name, this is not surgery. It uses precisely focused radiation to treat a tumor with no incision, and it is usually done in a single day without a hospital stay. It is often used for tumor that remains after an operation, for tumors that return, and for patients for whom surgery carries too much risk. Learn more about Gamma Knife »
What to Expect
Before surgery
You will have imaging, usually MRI and CT, and depending on your condition you may also see an endocrinologist for hormone testing, an eye doctor for vision testing, or an ear specialist for hearing testing. Your case is reviewed by the full team before a plan is recommended to you.
During surgery
Skull base operations here are often performed by two surgeons working together, typically a neurosurgeon and an ear, nose, and throat surgeon. Routine endonasal cases often take about two hours, and more complex cases can take four to six hours. When nerves are at risk, their function is monitored during the operation so the team can protect them in real time.
After surgery
Recovery depends on the operation. After surgery through the nose, you will move from the recovery room to a step down unit, and your family can join you once you are awake and oriented. Most patients go home after about two days. Nasal packing is usually removed within one to three days.
Nasal congestion and crusting are common afterward and can last for weeks to a few months. You will be seen by the ENT team to clean the nasal cavity during that time. Returning to work depends on the operation, and in some cases means avoiding heavy lifting for a few weeks while the repair heals. Your team will give you specific guidance at your follow-up visit.
Patients treated for pituitary tumors are followed by an endocrinologist to check hormone levels. Everyone is followed with imaging over time to make sure the problem does not return.
Why Patients Come Here
UPMC opened the first skull base center in North America and developed the endoscopic endonasal approach now used worldwide. More than 5,000 of these operations have been performed here since 1997, in adults and in children. Patients travel to Pittsburgh from across the country and from other countries for this care, and surgeons come here to learn it.
Learn more about the UPMC Center for Cranial Base Surgery and meet the team »
Make an Appointment
Call 412-647-3685, or 1-877-320-8762 from outside the United States.
See About Appointments for directions, parking, and what to bring. Patients traveling from outside the region can find help with travel and lodging through International Patients and Family House.