Skull Base Surgery

What is endoscopic skull base surgery?


This surgical approach allows the ENT surgeon and neurosurgeon to reach pituitary masses and other brain tumors and lesions at the skull base through the nasal cavity by using an endoscopic camera. The two surgeons work together in a team approach to enter into the skull base, visualize, and remove the tumor while keeping surrounding critical structures safe from harm.


What are risks of this surgery?


Risks of surgery include but are not limited to infection, bleeding, damage to surrounding structures such as the eye or intracranial cavity, damage to major vessels or nerves, leak of cerebrospinal fluid, meningitis, persistent olfactory dysfunction and septal hematoma/perforation. Although present, these are all minimal risks and have a low rate of occurrence when surgery is performed by experienced surgeons.


If, after you leave the hospital, you experience a consistent, clear, watery nasal drainage (like as if you have opened a sink faucet in your nose) from one or both nostrils that may worsen with leaning forward, please contact our team immediately as it may be evidence of a cerebrospinal fluid leak that requires surgical repair. However, please note that some drippy mucus and salty taste are expected when using the salt water spray.

Though an initial decrease in smell after surgery is normal due to the swelling and obstruction in your nasal and sinus cavities, let us know if there is a new and persistent loss of smell despite consistent saline rinsing at your second post-operative appointment, which is typically 6 weeks after surgery.


What happens after surgery?


After surgery, you will stay in the hospital for monitoring. The duration of this stay will depend on your particular tumor and surgery, but typically ranges from one to five days. It is completely normal to experience nasal mucus discharge and obstruction as there is expected post-surgical inflammation in the nasal and sinus cavities, and depending on the type of skull base reconstruction, you may have absorbable material bolstering that reconstruction in place. Until your first post-operative visit, we ask that you moisten your nose regularly with the recommended saline spray (~every 3 hours during the day is optimal), and this will be the primary way to keep your nose feeling as comfortable as possible.


Roughly two weeks after your procedure, you will have a scheduled post-operative visit with the ENT skull base surgeon. During this time, we will remove and clean out any mucus, blood and crust in your nasal and sinus cavities while being careful to leave the skull base untouched at that time for further healing. If things appear well, we will have you then start a nasal salt water rinse twice a day to remove any remaining clot and crust and further promote good healing.