Skull Base
What are Skull Based Neurosurgical Pathologies?
Skull base pediatric neurosurgery involves the diagnosis, treatment, and management of a variety of neurological conditions and tumors that affect the brain and or the surrounding structure at the base of the skull in children. This requires understanding of the relationship between of the complex boney structure that houses the brain, brainstem, cranial nerves, blood vessels, and other important anatomical structures. This allows to design specific procedures that minimize damage to the brain, while providing an optimal corridor to take care of the pathology at hand. Here are some examples of conditions that my team can help fix:
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Juvenile Nasopharyngeal Angiofibroma (JNA): A vascular tumor that often originates in the nasopharynx and have significant local erosion into the skull base.
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Rathke's Cleft Cysts: Fluid-filled cysts that develop in the sella turcica region, near the pituitary gland. Often benign, but its local growth can casue vision and hormonal impairement.
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Esthesioneuroblastoma (Olfactory Neuroblastoma): A tumor originating from the olfactory nerve in the nasal cavity that can extend into the skull base.
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Cranial Nerve Disorders: Conditions affecting cranial nerves, such as trigeminal neuralgia, tumors, autoimmune, or infectious disorders.
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Skull Base Trauma: Fractures or injuries to the bones at the base of the skull.
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Pineal Region Mass: Tumors or lesions that develop in the pineal region, potentially affecting vital functions. These tumors can be seen frequently in the pediatric population.
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Cholesterol Granuloma: A mass or cyst containing cholesterol and blood breakdown products that can occur in the skull base.
What Symptoms Might Skull Based Neurosurgical
Pathologies Cause in Children?
Skull based neurosurgical pathologies in children can cause a wide range of symptoms, depending on the specific type of pathology, its location, size, and its effects on surrounding structures. Some common symptoms that these pathologies might cause include:
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Headache: Persistent or severe headaches can be a symptom of various skull-based pathologies. The location and nature of the headache can provide clues about the underlying issue.
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Vision Problems: Pathologies affecting the skull base, especially those close to the optic nerves and chiasm, can lead to visual disturbances, such as blurred vision, double vision, loss of peripheral vision, or other visual field defects.
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Hearing Changes: Pathologies near the inner ear or auditory nerves can cause hearing loss, tinnitus (ringing in the ears), or other auditory disturbances.
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Facial Pain or Numbness: Compression or irritation of facial nerves can result in facial pain, tingling, or numbness.
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Balance and Coordination Issues: Pathologies near the cerebellum or brainstem can disrupt normal balance and coordination, leading to symptoms such as unsteady gait, dizziness, or difficulty with fine motor skills.
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Swallowing and Speech Problems: Pathologies affecting the cranial nerves responsible for swallowing and speech can lead to difficulty swallowing (dysphagia) or speech difficulties.
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Seizures: Some skull-based pathologies, particularly those involving abnormal growths of tissue, can trigger seizures.
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Changes in Mental Status: Depending on the location and size of the pathology, children might experience changes in their mental status, behavior, memory, or cognitive function.
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Nasal Symptoms: Pathologies involving the nasal passages or sinuses can cause symptoms such as nasal congestion, nosebleeds, or clear nasal discharge.
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Breathing Difficulties: Large or invasive skull-based pathologies can obstruct the airway and lead to breathing difficulties.
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Weakness or Paralysis: Pathologies affecting the nerves that control movement can result in muscle weakness or paralysis in specific areas of the body.
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Endocrine Changes: Some skull-based pathologies might affect the endocrine system, leading to hormonal imbalances and related symptoms.
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CSF (Cerebrospinal Fluid) Issues: Pathologies that obstruct the flow of cerebrospinal fluid can lead to symptoms of increased intracranial pressure, such as nausea, vomiting, and changes in consciousness.
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Unexplained Growth or Mass: Visible or palpable growths or masses on the skull or around the face can be indicative of underlying skull-based pathologies.
What Treatments are Available for Skull Based
Neurosurgical Pathologies in Children?
Once your child’s tumor is identified to involve the skull base and its size and location thoroughly assessed, I (as a pediatric neurosurgeon in New York) will work with you, your child, and other medical professionals (e.g., oncologists and radiologists) at Children's Hospital at Montefiore (CHAM)to formulate a customized treatment strategy tailored to your child’s needs. This customized treatment may utilize any one or a combination of the following interventions:
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Endovascular Procedures: For vascular lesions, such as arteriovenous malformations (AVMs), arteriovenous fistulas (AVF) and aneurysms, endovascular techniques may be used. This involves threading catheters through blood vessels to the site of the pathology and using techniques like embolization to block blood flow or promote clotting.
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Surgery: Surgical treatment involves the removal or resection of the lesion or tumor. Depending on the location and characteristics of the pathology, different surgical approaches may be used, including traditional open microsurgery and minimally invasive endoscopic techniques.
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Radiation Therapy:
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Stereotactic Radiosurgery (SRS): A non-invasive, one dose, treatment that delivers high-dose radiation precisely to the target area, often used for vascular lesions or tumors.
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Fractionated Radiation Therapy: The delivery of radiation in smaller doses over several sessions, suitable for larger lesions or tumors.
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Chemotherapy: Some tumors, once diagnosed, can be treated with chemotherapy either prior to surgery, after surgery, or on maintenance basis.
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Targeted Therapy: Specific medications or targeted agents may be used for certain types of tumors that have specific genetic mutations or characteristics.
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Cerebrospinal Fluid (CSF) Management: For conditions leading to CSF leaks, hydrocephalus, or other CSF-related disruption, surgical interventions such as endoscopic fenestrations, ETVs, shunt placement or repair of leaks may be required.
