What kind of tumours occur in the anterior skull base?

The anterior skull base includes the base of the skull above the eye sockets and sinuses. Tumours that can occur in this region include pituitary adenoma, meningioma, olfactory neuroblastoma, as well as paranasal sinus tumours.

How can they be treated?

Tumours in the anterior base skull sometimes can be treated with endoscopic surgery. These minimally invasive procedures are performed through the nose using specialised endoscopic cameras and instruments. These operations require intense planning and are perfomed by multidisciplinary teams including ENT, neurosurgery, intensive care, radiology and anaesthetic doctors specifically trained to perform this surgery.

Endoscopic Trans-Sphenoidal Hypophysectomy

What is endoscopic trans-sphenoidal hypophysectomy?

The pituitary gland is found at the case of the brain. It is responsible for producing various hormones important for body functions such as growth, blood pressure, function of the sex organs, thyroid gland, kidney function and some aspects of pregnancy, childbirth and breast milk production. Pituitary adenoma is benign overgrowth of the pituitary gland, which may on occasion cause overproduction of hormones of the pituitary gland and pressure on structures close to the gland in the brain (optic nerve). Certain pituitary growths can be treated with medicine alone (prolactinomas) whilst other tumours require surgery.

How does the procedure work?

Endoscopic trans-sphenoidal hypophysectomy is s minimally invasive surgical procedure performed in a multidisciplinary team (ENT and neurosurgeon). The operation is performed using specialised cameras (endoscopes) and instruments working through the nasal cavities and sphenoid sinus to access the pituitary growth.

How should I prepare for the procedure?

In all cases, your surgical team will need to conduct a CAT scan and/or MRI before surgery to see exactly where the tumour is located. Careful assessment is needed to fully ascertain the nature and extent of the tumour. This helps guide the surgery. The procedure is always performed under general anaesthetic in a hospital. You will be given specific instructions before your date of surgery instructing you when to stop eating/drinking and specific medication that may be needed before or after surgery.

What can I expect after the surgery?

You will be monitored very closely in intensive care immediately post-operatively. We pay very careful attention to managing your pain and kidney function after the procedure. A dissolvable material is placed into the nasal cavities after the surgery to help with healing and to minimise the risk of potential bleeding. Your neurosurgeon, endocrinologist, ENT, ophthalmologist and oncologist will determine if any further treatment is warranted after the surgery.

CSF Leak Repair

What is CSF?

Cerebrospinal fluid (CSF) is a clear fluid that surrounds the brain and spinal cord. Its function is to provide protection both as a mechanical buffer and immunological.

What is a CSF leak?

CSF leaks refer to the leaking of the fluid that surrounds the brain and spinal cord. This leaking can be caused by a tear in the membrane around the brain and spinal cord. When the fluid leaks out, the pressure in the brain decreases. Some common causes include traumatic injuries to the head, tumours or on occasion it may occur spontaneously without any cause. CSF leak increases the risk of developing meningitis (infection of the membrane that surrounds the brain).

What are the symptoms?

Some common symptoms include leaking clear salty water from the nose or ears, headaches, light sensitivity, nausea, and a stiff neck.

How can it be treated?

Occasionally CSF leak can stop without any intervention, but often the origin of the leak needs to be identified and repaired surgically. This can often be done with the use of a minimally invasive surgery whereby the surgeon accesses the tumours through the nasal cavities using specialised cameras and equipment.