Anatomy of a Comprehensive Skull Base Program: 2008–2018

For the past 10 years, a dynamic and comprehensive multidisciplinary skull base program has been successfully developed. Respecting the basic principles of skull base surgery, the program has benefited from personnel, organizational aspects, equipment and facilities, and academic attributes.

Personnel include leaders from adult and pediatric neurosurgery, otorhinolaryngology (ORL), and plastic and reconstructive surgery. Indispensable and collegial relationships are present with endocrinology, neuroophthalmology, neuroradiology, radiation oncology, medical oncology, neuro-anesthesia, neuropathology, neuro critical care, and a specialized nursing infrastructure.

Organizational aspects include a multidisciplinary clinic with simultaneous visits with endocrinology, ORL, ophthalmology. There is prompt availability of laboratory tests and imaging studies, and affiliated collaborative basic research and technical development.

Equipment and facilities consist of modern operating rooms with endoscopes, operating microscopes image guidance, intraoperative MRI and CT, and a hybrid endovascular operating room. There is a dedicated neuroscience ICU. Educational facilities include microsurgery and skull base dissection laboratories for residents and fellows.

Academic attributes of the skull base program include basic and clinical research laboratories, clinical trials, and outcomes research. Numerous publications have resulted from the program, including peer-reviewed scientific papers, books, book chapters, and guidelines. The program has supported and generated symposia instructional courses, master classes, meningioma days, and pituitary-day programs. Involvement in organizational activities and meetings both national and international has been part of the efforts of the program.

Surgical cases have been tracked from April 2008 through December 2017, and are steadily building. Craniotomies included 624 meningiomas, 132 schwannomas/neurofibromas, 56 chordoma/chondrosarcomas, and 121 procedures for a variety of other tumors and associated lesions. Transsphenoidal cases included 856 pituitary tumors, 103 Rathke’s cleft cysts, 38 craniopharyngiomas, and 105 other lesions of the anterior skull base. There were 25 additional pediatric endoscopic cases.

Additional craniotomy cases—132 (pineal tumors, epidermoids, hemangiomas, craniopharyngiomas, squamous cell cancers, olfactory neuroblastomas, lymphomas, SCO, sinonasal adenocarcinomas, cholesteocytomas, glomus tumors, choroid plexus tumors, ependymomas, adenocystic cancers, hemangiopericytomas, leiomyosarcomas, plasmacytomas, leukemia, and miscellaneous lesions).

Additional transsphenoidal cases—105 (meningiomas, metastatic carcinomas, dermoid/epidermoids, pituicytomas, granular cell tumors, germinomas, chordoma, myopericytoma, squamous cell carcinoma, lymphoma/leukemia, and miscellaneous lesions).

ORL primary procedures included 15 middle fossa procedures for canal dehiscence, tegmen defect, and CSF leak; 2 labyrinthectomies; 8 temporal bone resections; 7 infratemporal fossa lesions; 19 cochlear implants.

Pediatric skull base cases—25 skull base tumors, 77 vascular bypass procedures for moyamoya, and related vascular insufficiency and aneurysms. There were numerous cases for craniofacial reconstruction.

Conclusion: It has been rewarding to see the continued interest in and growth of skull base surgery as an exciting and sophisticated specialty. These advances have been responsible for major improvements in surgical care and for the quality of life for our patients.

No conflict of interest has been declared by the author(s).