Skull Base Tumours
The skull base implies the base or floor of the cranium, the part of the skull on which the brain rests. It consists of five bones, separating the brain from the paranasal sinuses, ears, eyes, and other parts of the head.
These bones are:
- Ethmoid bone, which divides the nasal cavity from the brain
- Sphenoid bone, a complex bone that constitutes the skull base and the sides of the eye
- Occipital bone, which forms the back of the skull and gives passage to the spinal cord
- Pair of frontal bones, which constitute the forehead and the eyebrow part
- Pair of temporal bones, which constitute the lateral walls of the skull
Most common symptoms:
- Persistent nasal congestion not responding to general treatment
- Frequent headaches
- Facial pain
- Bleeding from nose, ears
- Swelling around the eyes
- Decreased sense of smell
- Numbness of the cheek and upper lip
- Double vision
- Hearing loss
- Ringing sensation in ears
- Weakness of one half of face
HOW DO WE DIAGNOSE?
To find the cause of symptoms, a surgical oncologist evaluates a person’s medical history, performs a physical examination(nose, nasopharynx,ears,neck,neurological deficits) and orders diagnostic tests. The examination and tests conducted may vary depending on the symptoms.
- A nasopharyngoscope may show the tumor in the nasal cavity or nasopharynx.
- X-rays of paranasal sinuses.
- CT scan /Magnetic resonance imaging (or MRI) of PNS and Skull base.
- PET scan in selected cases.
TUMOR BOARD/ MULTISPECIALTY CLINIC EVALUATION
Each and every Head & Neck cancer patient is evaluated by a special team of Surgical Oncologists (Head & Neck unit), Medical Oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology, and stage of the disease, a custom-made treatment plan is charted out for each and every patient as per International Treatment Guidelines. (NCCN – National Comprehensive Cancer Network)
- Lateral temporal bone resection
- Anterior skull base surgery
- Craniofacial Resection
- Orbital Exenterations
DO’s after Surgery
- Keep a small drip pad under your nose for first few days.
- Resume a healthy, balanced, normal diet as you feel up to.
- Minimize your activities with only light activity for the first week.
- All medicines as prescribed in the discharge note along with medicines for chronic diseases like diabetes, hypertension, thyroid-related, and asthma should be continued as earlier.
- Oral hygiene with Betadine mouth wash in 1:1 ratio with water to be done every 2 hourly.
- Resume your home medications that are not blood thinners
- Sleeping at a 300 head-up position.
- Care of the drain and output charting as advised (you can see the video attached for reference).
- Care of the wound as advised.
DON’Ts after surgery
- Avoid sudden exertion to the head and neck area while getting up from bed.
- No nose blowing, stooping, straining or heavy lifting of more than two bag of groceries. Sneeze with your mouth open.
- Do not take any aspirin containing products or blood thinners until told by your surgeon.
- Do not take intranasal spray other than saline until told by your surgeon.
- Do not drive, operate dangerous machinery, or do anything dangerous if you are taking narcotic pain medication.
- Avoid addictions.
- Avoid brushing your teeth if there are stitches in the mouth.
- Avoid water entry into the ears if lateral skull base surgery has been done.
When to contact the treating team?
- As per appointment.
- If the swelling around the neck wound or facial wound increases suddenly or within few hours.
- Fresh bleeding from neck wound or oral cavity or nose. Minimal blood-stained discharge from neck or facial wound or during mouth wash is acceptable.
- If there’s difficulty in breathing or swallowing, fever.
- If there’s profuse watery discharge from the nose or ears which doesn’t stop by itself.
MBBS, MS, M.Ch.
Dr. A.K. Dewan Head & Neck Surgical Oncology
MS(Surgery), MRCS(Edinburg), M.Ch. Surgical Oncology
Dr. Mudit Agarwal Head & Neck Surgical Oncology
Dr. Vikas Arora Head & Neck Surgical Oncology
MBBS, DLO, DNB (ENT)
Dr. Ghanshyam Mandal Head & Neck Surgical Oncology
MBBS, MS, FHNS
Dr. Vishal Yadav Head & Neck Surgical Oncology