As a surgeon, I am motivated by the challenge skull base tumors represent — both their complexity and the impact that they have on our patients. Because not that long ago, many of these tumors were considered incurable.
Before skull base surgery was developed as a field, neurosurgeons would go as low as they could go, and head and neck surgeons would go as high as they could go. Both would stop at the skull base — the bony platform behind the eyes and nose that slopes down toward the back of the head. That meant sometimes part of a tumor got left behind — where it could grow right back.
Today, we know that skull base tumors are curable. It takes many types of brain and spine and head and neck specialists working together to treat them effectively. But we do that here at MD Anderson. And being involved in that process is the most rewarding part of my job.
Why skull base tumors are difficult to diagnose
Skull base tumors are rare, so they are often difficult to diagnose. The average doctor will probably see less than a handful in their entire career. That’s why it’s important to seek treatment at a place like MD Anderson — because even rare tumors aren’t rare here.
Patients frequently come to us with a particular diagnosis, but when we review their reports with our dedicated head and neck and neuropathologists, we sometimes come to a different conclusion. This happens more than 30% of the time. So, for one out of every three skull base tumor patients, we say, “Nope. You have this instead of that.”
One reason is that there are many different types of skull base tumors. They can originate in the head or neck (nasal, sinuses, ear or salivary gland), in the brain (meningioma, chordoma, acoustic neuroma or pituitary gland), or in the skull base itself (usually sarcoma). Not all of them are cancerous. But all of them can affect a patient’s most basic functions, such as breathing, eating and walking.
Successful skull base tumor treatment requires multidisciplinary care
Regardless of the type of skull base tumor, they’re all difficult to treat, because of their location deep inside the head. This makes them challenging to access. The skull base involves many vital structures, such as major blood vessels and nerves that control vision, hearing, balance and gait. So, skull base tumors can’t be resolved by a simple surgery or a single specialist.
At MD Anderson, a skull base tumor patient may see a neurosurgeon, a head and neck surgeon, a temporal bone surgeon, a plastic surgeon and an ophthalmologic surgeon. They may also have a medical oncologist, a radiation oncologist, a neuro-oncologist, and a head and neck medical oncologist.
That’s what makes our multidisciplinary approach to care so critically important. Every member of a patient’s team has to work together with all the others to provide the best possible result. And we do.
How MD Anderson is advancing skull base tumor treatment
One area in which MD Anderson has really led the way is in developing and pioneering a “minimal access” approach to skull base tumors. In these procedures, surgeons use natural passages (such as the sinuses or nasal cavity) to reach these growths, instead of making cuts to the face or removing large sections of bone from the skull. This is a huge advance for our patients, as it means fewer extreme surgeries and shorter recovery times.
One study we published earlier this year on sinonasal undifferentiated carcinoma is revolutionizing the way that type of cancer is being treated. The study found that patients who received chemotherapy and radiation therapy before surgery had much higher survival rates five years after diagnosis than those who received surgery first. These findings are changing the way this disease is treated both here at MD Anderson and globally.
Where you go first for skull base tumor treatment matters
Skull base tumors are curable. But it’s much harder to treat them when you’re dealing with a cancer that has come back or one that never really went away to begin with. So, getting the right treatment up front makes all the difference. Your chances of survival are higher, and your results and quality of life are better.
That’s why, for me, performing surgery on patients with skull base tumors today is far more than just a technical exercise in removing cancer from a difficult area.
It’s about stepping into someone’s life at a very vulnerable point — possibly the most-vulnerable point — and guiding them safely through the storm.
Ehab Hanna, M.D., is vice chair of Head and Neck Surgery at MD Anderson and co-director of the Skull Base Tumor Program.
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