Description

Tumors of the skull base are tumors that form in the area of the skull, just behind the eyes and the nose, below the brain. The base of the skull is where the major blood vessels and nerves come together with the spinal cord. The base of the skull also separates the brain of the neck.

The tumors can also be called masses, tumors, or injury. These tumors can grow on the inside or on the outside of the skull. They can be benign (non-cancerous) or malignant (cancerous). Some of tumors of the skull base may not cause any symptoms, but others can cause symptoms that affect the senses, such as vision or hearing, and the manner in which the nervous system works.

Even non-cancerous skull base tumors can be dangerous. These tumors can put pressure on the blood vessels, nerves, and brain tissue at the base of the skull. This can lead to hearing loss, vision problems, dizziness, and other problems that affect the safety and well-being.

Types of tumors of the skull base

Types of skull base tumors are characterized by the fact of whether they are cancerous or non-cancerous, and where the growth of tumors in the base of the skull. Some tumors begin to grow elsewhere in the body and expand the base of the skull.

There are many types of tumors of the skull base. Some of the most common types of benign, also known as benign, skull base tumors include:

  • Acoustic Neuroma. It is also called a vestibular schwannoma, this type of tumor grows in two of the nerves that help with hearing and balance. Acoustic neuromas tend to grow slowly.
  • Meningioma. This type of skull base tumor starts to grow in the cells of the membrane that covers the brain and spinal cord. This membrane is called the meninges. Rarely, meningiomas may be cancerous and grow aggressively.
  • Tumor of the pituitary gland. This type of tumor that forms in a pea-sized gland called the pituitary gland, located at the base of the skull.
  • Paraganglioma. This type of tumor usually grows on the head and neck. While it is possible that a paraganglioma to be cancerous, usually it is not.
  • The Osteoma. This type of tumor is of dense bone tissue. The osteoma grow slowly and the shape of the bones of the base of the skull. Can also be found in the sinuses.

Other rare types of skull base tumors include craniopharyngiomas, tumors of granule cells and angiofibromas.

Malignant tumors

Some of the most common types of cancerous lesions, also known as malignant, tumors of the skull are:

  • Chordomas. These types of tumors tend to grow slowly, starting in the bones of the base of the skull or spine. Chordomas often causes problems with vision and hearing, balance, and headaches.
  • Chondrosarcomas. These tumors often develop in the bones, but can also grow in the vicinity of soft tissue called cartilage. Chondrosarcomas can occur in the bones of the base of the skull. These tumors tend to grow slowly.
  • The Carcinomas. There are several types of base of skull carcinomas, including adenoid cystic carcinomas, nasopharyngeal carcinomas, squamous cell carcinomas and adenocarcinomas. These tumors can grow in the salivary glands, nasal cavity, sinuses, and the head and neck. Adenoid cystic carcinomas tend to grow slowly, but they tend to spread to close to the nerves and tissues.
  • Olfactory neuroblastomas. These are very rare tumors that grow in the nasal cavity. They are also called esthesioneuroblastomas. These tumors can cause bleeding of nose and loss of sense of smell, and can spread to the areas around the eyes and the brain.

Symptoms

Symptoms of skull base tumors are different according to the size of the tumor, type of tumor, where the tumor is growing in the base of the skull.

Some of the most common symptoms of tumors of the skull base are:

  • Headaches.
  • The neck pain.
  • Changes in vision, blurred or double vision or loss of vision.
  • Changes in hearing — hearing loss or ringing in the ears.
  • Problems with gait and balance.
  • Clumsiness or problems with coordination.
  • The hoarse voice.
  • Problems with breathing or swallowing.
  • Changes in your sense of smell.
  • Nosebleeds.

Tumors of the skull base may not cause any symptoms. Or the symptoms may be mild and general. Some symptoms may include: headaches, or problems with balance. Tumors of the skull base may be found by accident during imaging scans, or other tests to find the cause of other symptoms.

When to see a doctor

Make an appointment with a doctor or other health care professional if you have any symptoms that worry you.

Causes

Experts are not sure what causes the majority of tumors of the skull base. The majority of tumors of the skull base seem to be developing without a clear cause. It is believed that some of tumors of the skull base, particularly acoustic neuromas, are likely caused by genetic conditions that run in families. However, many other factors can also contribute. These factors include exposure to radiation and harmful chemicals.

It is likely that a combination of factors in the genes and the environment due to tumors of the skull base.

Risk factors

While experts do not know exactly what causes the majority of tumors of the skull base, there are several factors that seem to increase the risk of developing tumors of the skull base. The risk factors for tumors of the skull base include:

  • Genetic conditions. Inherit certain conditions, through changes in the genes that can cause some types of tumors of the skull base. These changes in genes that can cause the growth of tumor cells. The Neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) are genetic diseases that can cause acoustic neuromas and other types of the base of the skull to the tissue.
  • Exposure to certain chemicals. Long-term exposure to toxic substances such as vinyl chloride, herbicides, and arsenic may increase the risk of developing tumors of the skull base called carcinomas, particularly in the nasal passages and sinuses of the areas. Cancer-causing substances, such as asbestos, formaldehyde and wood dust have been associated with the development of certain skull base cancers, particularly cancer of the sinuses. Exposure to high particulate air pollution — where there are solid particles in the air that can be inhaled into the lungs — and radon are also associated with some tumors, especially meningiomas. These chemicals can cause mutations in the cells that line the sinuses and the nasal cavity, which can lead to cancer.
  • The history of radiation exposure. Be there before radiotherapy, especially aimed at the head and the neck, can contribute to the growth of the skull base tumors.
  • Frequent infections of the sinuses. Infections of the sinuses may be a risk factor for certain types of tumors in the skull base, especially in the nasal cavity and paranasal sinuses.
  • The hormonal changes. These are thought to play a role in the development of some tumors of the skull base. It is believed that changes in hormones during puberty can contribute to the growth of some of these tumors. Tumors of the pituitary gland is also affected by changes in hormones.
  • The history of the family. Having a family history of tumors or genetic diseases such as neurofibromatosis, multiple endocrine neoplasia, or other hereditary cancer syndromes increases the risk of developing tumors of the skull base.
  • The previous history of the tumors. If you've previously been diagnosed with a tumor, especially in the head or neck, you may be at higher risk of developing a secondary to skull base tumor. This may be due to factors such as previous radiation treatment or shared risk factors for tumors.
  • Smoking and the consumption of alcohol. These factors are linked to an increased risk of certain skull base tumors, such as squamous cell carcinoma of the paranasal sinuses or nasopharynx. The nasaopharynx is the upper part of the throat that connects to the nasal cavity.

It is important to highlight that the existence of any of these risk factors does not mean that you have a tumor of the base of the skull. Not all people with these risk factors have a tumor of the base of the skull. Some people develop tumours without known risk factors.

Complications

Complications of skull base tumors are usually caused by tumors growing and pressing on blood vessels, nerves and other tissues, including the brain.

Nervous system complications may include:

  • Problems with vision.
  • The hearing loss.
  • Weakness or numbness in the face.
  • Difficulty swallowing or speaking.
  • Difficulty breathing.
  • Seizures.
  • Headaches.
  • The cerebrospinal fluid leak.
  • The accumulation of water in the brain, which can increase the pressure inside the skull and cause headaches, nausea, and vomiting.

Other complications may include:

  • Changes in hormone levels.
  • Infections, such as meningitis.
  • Problems with memory, concentration, mood, or behavior.
  • Problems with balance, coordination and walking.
  • The stroke or bleeding in the brain.
  • Problems with the eustachian tube in the ear.

Sometimes tumors of the skull base can be extended. Non-cancerous skull base tumors usually do not spread. Cancer of the base of skull tumors can grow into nearby tissue and spread to the lymph nodes, the lungs, the liver or other parts of the body. Chordomas, chondrosarcomas, carcinomas sinonasal and olfactory neuroblastomas are more likely than other types of tumors of the skull base to spread throughout the body.

Whether or not to skull base tumors spread, and the speed with which you do this depends on the type and grade of the tumor. High-grade cancerous tumors are more aggressive. It is likely to spread more quickly than low-grade tumors. The grade of a tumor shows how different the cells of the tumor are healthy cells. High-grade tumors have irregular cells and tend to grow and spread very quickly.

Diagnosis

Your doctor or other health care professional will ask about your medical history and the symptoms that you have. Also will have a physical exam to check your vision, hearing, balance, coordination, sensation, strength and reflexes. This can help your healthcare provider figure out which part of your brain that could be affected by the tumor.

Other tests for the diagnosis of skull base tumors may include:

  • Imaging tests, such as computerized axial tomography, magnetic resonance imaging or a PET scan. These tests take pictures of your brain and the surrounding structures to show the size and location of the tumor. It can also show if there is any kind of pressure or obstruction of the cerebrospinal fluid, which is the fluid that surrounds the brain and the spinal cord.
  • The biopsy. In this procedure, a health care professional takes a small sample of the tumor and sent to a lab to be tested. A biopsy is done by removing a small part of his skull and the use of a needle to take a sample of the tumor.
  • Blood tests. Your health care professional may obtain a blood sample and test your hormone levels and other laboratories, which may indicate the presence of certain types of tumors.
  • The hearing and vision tests. Because the base of the skull tumors can affect hearing and vision, these tests are necessary to detect problems with the function and to examine the nerves to see if the tumor is compressing the nerves.

The prognosis and life expectancy with skull base tumors depends on many factors, such as the type of tumor, tumor grade, tumor location, your age, and your health in general.

Treatment

There are several options for the treatment of a tumor of the base of the skull. Your health care team takes into account many factors when creating a treatment plan. These factors can include the location of the tumor, how fast it is growing, if it has spread to other parts of the brain. Other factors include the results of the tests in the cells of the tumor, and whether the tumor is causing symptoms. Your health care team also takes into account your age and your overall health.

The goal of treatment of tumors of the skull base is to remove the tumor or stop the growth of the tumor without causing damage to nearby tissues.

The treatment options include:

  • Surgery.Usually, surgery is the first treatment of tumors of the skull base. This is done to remove the tumor from the base of the skull, either partially or fully. The surgery to remove the tumor may not be the best option for skull base tumors that have a higher risk of complications with the removal. The surgical techniques may include cutting a small section of the skull so that surgeons can access the brain to remove the tumor. There are less invasive surgeries such as the endoscopic surgery. This technique allows surgeons to use a thin tube with a camera through the nostrils. The surgeon uses a small surgical tools, which is placed in the nostril with the tube, to remove the tumor. Surgeons can use advanced technologies, such as intraoperative mri, to guide them during surgery.
  • The radiation therapy.This type of therapy uses highly focused, powerful beams of energy, usually X-rays, to destroy tumors. For skull base tumors, radiation therapy may be used after surgery to destroy tumor cells not removed by surgery. There are several types of radiation therapy available, including stereotactic radiosurgery. This type of goals of therapy for skull base tumors with a very high dose of energy beams directed at the tumor, avoiding nearby cells and tissues. Stereotactic radiosurgery is generally used in small tumors. Another type of radiation therapy is fractionated radiation therapy. Instead of an intense session, small doses of-rays of energy are delivered in several sessions during the course of a couple of weeks. Fractionated radiation therapy is usually used on larger or more complicated tumors. Proton therapy may also be used for the treatment of tumors of the skull base. This type of radiation therapy used particles called protons instead of X-rays (photons) beams. Proton therapy targets the tumor with higher accuracy. Can be used for the treatment of tumors located near the optic nerves, the brainstem, or other risk areas.
  • Chemotherapy.This treatment consists of very strong medication designed to kill or stop the growth of tumor cells. There are many different types of chemotherapy drugs. These can be administered through a vein or a pill that is swallowed. Chemotherapy may be used after surgery or in addition to the other treatments. Chemotherapy was used less often for skull base tumors, unless they are cancerous and grow very quickly. Can be used in combination with other therapies for cancers such as cancer of the sinuses.
  • Watchful waiting. Some people may not need treatment for some tumors of the skull base. These tumors may include small, non-cancerous tumors that do not cause any symptoms. Instead, your health care professional may suggest the monitoring of the tumor with regular imaging tests to verify the changes.

Surgery. Usually, surgery is the first treatment of tumors of the skull base. This is done to remove the tumor from the base of the skull, either partially or fully. The surgery to remove the tumor may not be the best option for skull base tumors that have a higher risk of complications with the removal. The surgical techniques may include cutting a small section of the skull so that surgeons can access the brain to remove the tumor.

There are less invasive surgeries such as the endoscopic surgery. This technique allows surgeons to use a thin tube with a camera through the nostrils. The surgeon uses a small surgical tools, which is placed in the nostril with the tube, to remove the tumor.

Surgeons can use advanced technologies, such as intraoperative mri, to guide them during surgery.

The radiation therapy. This type of therapy uses highly focused, powerful beams of energy, usually X-rays, to destroy tumors. For skull base tumors, radiation therapy may be used after surgery to destroy tumor cells not removed by surgery.

There are several types of radiation therapy available, including stereotactic radiosurgery. This type of goals of therapy for skull base tumors with a very high dose of energy beams directed at the tumor, avoiding nearby cells and tissues. Stereotactic radiosurgery is generally used in small tumors.

Another type of radiation therapy is fractionated radiation therapy. Instead of an intense session, small doses of-rays of energy are delivered in several sessions during the course of a couple of weeks. Fractionated radiation therapy is usually used on larger or more complicated tumors.

Proton therapy may also be used for the treatment of tumors of the skull base. This type of radiation therapy used particles called protons instead of X-rays (photons) beams. Proton therapy targets the tumor with higher accuracy. Can be used for the treatment of tumors located near the optic nerves, the brainstem, or other risk areas.

Chemotherapy. This treatment consists of very strong medication designed to kill or stop the growth of tumor cells. There are many different types of chemotherapy drugs. These can be administered through a vein or a pill that is swallowed. Chemotherapy may be used after surgery or in addition to the other treatments.

Chemotherapy was used less often for skull base tumors, unless they are cancerous and grow very quickly. Can be used in combination with other therapies for cancers such as cancer of the sinuses.

Potential future treatments

The current research in the treatment of cancer and neurosurgery can lead to potential future treatments for skull base tumors. While the current methods of treatment such as surgery, radiotherapy and chemotherapy remain the standard methods, advances in technology, drug development and precision medicine offer new possibilities for more effective and less invasive treatments.

Gene therapies and immunotherapy show the potential as well as the drugs that attack and destroy specific cells in the base of the skull tumor. The researchers are also exploring new ways of using existing techniques, including proton therapy, and endoscopic surgery.

Alternative medicine

There are No other medicines that can cure tumors of the skull base. But some complementary and alternative treatments may help with the common symptoms of tumors. These may include pain, fatigue, and stress.

Some alternative and complementary therapies that may be useful include:

  • Meditation, guided visualization, and other mindfulness practices.
  • Yoga.
  • The relaxation exercises.
  • Acupuncture.
  • Massage therapy.
  • The physical activity.

If you are interested in alternative medicines and complementary therapy for skull base tumors, talk with your health care team. Ask about the potential benefits and risks. And discuss with your health care team about what options might be helpful and safe for you.

Coping and support

Learning that you have a tumor of the skull base can be overwhelming. But you can take steps to cope after their diagnosis. Take steps to:

Find out all you can about your type of tumor of the base of the skull

Write down your questions and bring them to your appointments. As your health professional responds to your questions, take notes. Or ask a friend or family member to come along to take notes.

The more that you and your family know and understand about your care, the more confident you'll feel when it is time to make treatment decisions.

Get support

Find someone with whom to share their feelings and concerns. You can have a close friend or family member who is a good listener. Or speak with a member of the clergy or a counselor.

You may find it helpful to talk with other people who have had tumors of the skull base. Ask your health care team about support groups for people with tumors of the skull base. These support groups can be available online and in your area.

Take care of yourself

Choosing a healthy diet that is rich in fruits, vegetables and whole grains whenever possible. Consult with your healthcare professional to see if it is safe for you to do exercise. Get enough sleep to feel rested.

Reduce the stress in your life by taking time to relax activities, such as listening to music or writing in a journal.

Preparing for your appointment

If you have symptoms that worry you, make an appointment with a doctor or other health care professional. If you have a tumor of the base of the skull, it'll most likely be referred to a specialist.

Specialists who care for people with skull base tumors include:

  • Physicians who diagnose and treat brain and spinal cord conditions, called neurologists.
  • The surgeons operating on the brain and the spinal cord, call of neurosurgeons.
  • Physicians who diagnose and treat tumors that affect the bones, called orthopedic oncologists.
  • The surgeons operating on the bones and joints, called orthopedic surgeons.
  • Physicians who diagnose and treat ear, nose and throat conditions and head and neck conditions, called otolaryngologists.
  • Physicians who diagnose and treat conditions that affect hormones and the endocrine system, called endocrinologists.
  • Physicians who diagnose and treat disorders that affect the eyes and vision, called ophthalmologists.
  • The medical uses of radiation to treat cancer and tumors, so-called radiation oncologists.
  • The doctors use drugs to treat cancer, called the medical oncologists.

Here's some information to help you prepare for your appointment.

What you can do

  • Write down any symptoms you've been experiencing and for how long you have had them.
  • The list of your key medical information, including all the conditions that you have and the names of the medicines you are taking. Include prescription drugs and medicines you can buy without a prescription.
  • Note any family history of skull base tumors, especially in a first-degree relative, such as a father or a brother.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Write down questions to ask your health care professional.

Questions to ask at your first appointment are:

  • What can be causing my symptoms?
  • There are other possible causes?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What do you recommend for the next steps in the determination of my diagnosis and treatment?
  • You should see a specialist?

Questions to ask an oncologist or neurologist include:

  • I have a tumor of the base of the skull?
  • What type of tumor of the base of the skull I have?
  • How will the tumor to grow with time?
  • What could be the consequences?
  • What are the objectives of my treatment?
  • Am I a candidate for surgery? What are the risks?
  • Am I a candidate for radiation therapy? What are the risks?
  • I'm going to need chemotherapy?
  • What treatment approach do you recommend?
  • If the first treatment does not succeed, what are we going to do next?
  • What is the outlook for my condition?
  • I need a second opinion?

In addition to the questions you have prepared, do not hesitate to ask any questions that may arise during your appointment.

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health history. The questions may include:

  • What are your symptoms?
  • When did you first notice these symptoms?
  • The symptoms worsened over time?
  • If you have pain, where does the pain seems to start?
  • Does the pain spread to other parts of your body?
  • Have you participated in any of the activities that could explain the pain, as a new exercise or a long stretch of gardening?
  • Have you experienced any weakness or numbness in the legs?
  • Have you had any difficulty walking?
  • Has had problems with bladder or bowel function?
  • Have you been diagnosed with any other medical condition?
  • Are you currently taking any medicine, including prescription drugs and medications that can be purchased without a prescription?
  • Do you have any family history of, or non-cancerous tumors?
Symptoms and treatment of tumors of the Skull base