Diagnosis Of Problems In The Skull Base
If you have any symptoms that point to growth or abnormality in the skull base, you will have a thorough physical examination
1 . Physical exam
During this, your doctor will thoroughly analyse your symptoms. You will have a few clinical tests to assess the nerves that may be responsible for the symptoms. If the physical exam points to a skull base abnormality, you will have a few other tests.
2. Imaging tests
You will have an MRI and CT scan of the base of the skull. These scans will show any problems at the base of the brain. Problems with nerves, blood vessels, and bones at the base of the skull will also be very clear in these scans.
If your neurosurgeon suspects a tumor, you will have a contrast MRI scan with spectroscopy and tractography. It helps to assess the type and extent of tumor.
A biopsy is a test to confirm whether a tumor is cancerous or not. Infections of the skull bones will also need a biopsy to confirm the nature of the infection.
Types Of Skull Base Surgery
Skull base surgery is mainly of two types. They are:
(i) Minimally invasive endoscopic surgery
In this surgery, the neurosurgeon reaches the skull base through natural openings of the nasal cavity, sinuses, etc. The neurosurgeon may also gain access by creating small openings in the bone above the eye or behind the ear.
Patients will have general anaesthesia for the procedure. The neurosurgeon will insert an endoscope, which is a flexible tube-like instrument with a light and camera at the tip. It helps the neurosurgeon to see the area of surgery on a large screen.
The neurosurgeon will then insert small surgical instruments through the endoscope to do the surgery. The main advantage is that risks and complications are less in number in comparison to open surgery. Recovery is also faster with this type of surgery.
(ii) Open surgery
In some skull base problems, it is difficult to reach the involved area through minimally invasive surgery. In such cases, the brain surgeon will go for open surgery. A patient for open surgery will have general anaesthesia.
The brain surgeon will then remove a part of the skull close to the problem area through a craniotomy. After the surgery, the brain surgeon will replace the bone part in its original position and secure it with wires, screws, or plates.
Your recovery will depend on the type of surgery. If you have endoscopic surgery, your recovery will take two to three weeks. Recovery from an open surgery will need a few weeks more.
During the recovery period, you will have to visit the hospital at regular intervals. Your neurosurgeon will assess your progress as well as do a few tests to ensure that everything is fine.
Most of the skull base surgeries are safe. But like other surgeries, there are a few risks and complications as well.
Risks and complications
Leakage of CSF into the nose is the most important risk to be noted. CSF is a fluid that lies in between the layers of the meninges. An accidental tear of the meninges during skull base surgery can cause it to leak into the nose.
Repair surgery is necessary to correct this problem. Other common risks occur due to problems with cranial nerves during skull base surgery. Most of these are temporary and gets better within a short time.
These include a loss of smell, taste, hearing, etc. There will also be numbness, weakness, or pain in some areas of the face as well. For diagnosis and treatment consult Dr Gurneet Sawhney, an experienced neurosurgeon in Mumbai.