Skull base surgery

Skull base surgery involves the management of a wide variety of conditions that affect this area. 

Skull base surgery is extremely complex as it includes the eye sockets, ears, nose and sinuses and all of the connections between the brain and the rest of the body, including the blood supply to the brain.  

As a speciality it therefore includes surgeons from many different disciplines including ENT, Neurosurgery, Maxillo Facial surgery and Ophthalmic surgery.  

The skull base service at The Walton Centre has very strong links with these specialities at Aintree University Hospital.  We work as a multidisciplinary team, along with oncologists, radiologists, specialist nurses, physiotherapists and audiologists to provide optimal management and support of patients with skull base pathology. 

The conditions that affect this area are most commonly tumours, but also include infections, congenital abnormalities and other bone disorders such as fibrous dysplasia.

 

Tumours affecting the skull base:

  • Schwannomas, most commonly vestibular schwannomas also known as, acoustic neuromas
  • Meningiomas
  • Pituitary adenomas
  • Craniopharyngiomas
  • Tumours of the bone/cartilage:
    • Osteomas
    • Chondromas
    • Chondrosarcomas
    • Chordomas
    • Osteosarcomas
  • Paragangliomas / Glomus Jugulare tumours
  • Dermoids and Epidermoids
  • Benign and Malignant Tumours of the skin, ear, nose and sinuses that invade the skull base and brain
  • Metastases

Management

Many of these tumours are benign, slow growing and readily diagnosed on imaging, therefore the management depends on the size, location, symptoms, tumour behaviour (i.e. is it growing), and the age and fitness of the patient. 

Surgery

When surgery is required the procedures are often long due to the complex anatomy in this area.  Tumours are removed to the maximal extent whilst preserving neurological function, using image guidance systems, neurophysiology, e.g. facial nerve and other cranial nerve monitoring, intraoperative ultra sound and Doppler.


Radiotherapy

Some tumours can be managed with fractionated radiotherapy or stereotactic radiosurgery.  Stereotactic radiosurgery is provided on site at the Clatterbridge Cancer Centre Liverpool where there is a Novalis TX machine.


Support for patients with skull base tumours

The Neuro-oncology nursing team is a dedicated team of nurses who specialise in supporting patients with brain and spinal tumours. A diagnosis of a skull base tumour can be a very frightening time for patients and their families.  The clinical nurse specialist team are available to offer support.

To contact the neuro-oncology clinical nurse specialist team:

The British Acoustic Neuroma Association is an excellent source of information and support for patients with acoustic neuromas.

The local acoustic neuroma support group meets with the tinnitus support group. For more information contact Chris Jones on 0151 493 2800 or email chris.jonesteach@gmail.com.

Patients with Acoustic Neuromas and other tumours in this area can develop tinnitus and/or balance disturbance.

The tinnitus support group, led by Senior Audiologist Tony Kay, meets on the first Wednesday of each month in Room 207 at the Clinical Science Centre, Aintree University Hospital, 6 – 7.30 pm.  

For more information, please visit the local group website here: http://www.aintreehospitals.nhs.uk/hospital_services/aintree_tinnitus_support_group.asp

The balance support group meets on the first Wednesday of each month in room 207 at the Clinical Science Centre, Aintree University Hospital, 2.15 – 4pm.

For more information about the tinnitus and balance support groups, please call 0151 5290328 or email: audiology@aintree.nhs.uk.

The Skull Base Team

Skull Base surgeons

Miss Catherine Gilkes, Neurosurgeon
Tristram Lesser, ENT
Nazia Munir, ENT
Ahmed Youssef, ENT
Samuel Leong, ENT
Andrew Swift, ENT  
Prof James Brown, Max Fax  
Richard Shaw, Max Fax
Austin McCormick, Ophthalmology
James Hsuan, Ophthalmology
Jawad Yousaf, Neurosurgeon

Skull Base Specialist Nurses:
Emma Wilby
Chloe Clayton

ENT specialist nurses:
Rebecca Donald, Trainee Advanced Nurse Practitioner
Nichola Carmichael, Trainee Advanced Nurse Practitioner
Charlotte Halpin, Trainee Advanced Nurse Practitioner
Caroline Smith, Nurse Practitioner

Oncologists:
David Husband
Adi Shenoy

Audiologist:
Tony Kay

Vestibular rehabilitation and facial nerve physiotherapy:
Nova Mullin
Cathy Morrow

Documents

Skull Base Pathways/documents