Skull base surgery: a treatment for once-inoperable brain tumors

For decades, tumors located at the base of the skull were often considered inoperable because they sit among vital blood vessels and nerves essential to basic human function. However, skull base surgery is an advanced and highly specialized procedure that allows surgeons to safely reach areas of the brain that were previously inaccessible.

According to neurosurgeon Miguel Lopez-Gonzalez, MD, skull base surgery offers hope to patients with complex neurological conditions by treating tumor conditions located at the bottom portion of the brain, where the spinal cord is connected. 

“Major arteries carrying blood from the neck to the brain pass through the skull base, along with tiny nerves responsible for vision, hearing, smell, swallowing, facial movement, and speech,” Lopez-Gonzalez explained. “Because of this complexity, surgeons must carefully navigate around vital structures while removing tumors or repairing abnormalities.” 

Unlike procedures performed at the top of the skull — which may only require a small opening — skull base surgery requires carefully planned surgical pathways tailored to each patient. 

Procedure planning and surgical approaches

Before surgery, patients undergo imaging to map the brain and surrounding structures in detail. With this information, surgeons can determine the safest surgical route using different entry points depending on their location, including:

• Side of the head

• Behind the ear

• Back of the skull

• Around the eye socket

• Through the nose

During the procedure, advanced navigation systems act like a GPS, guiding surgeons to precise locations while avoiding critical nerves and vessels. Because of the complexity involved, skull base surgery typically requires a multidisciplinary team. Neurosurgeons frequently collaborate with ear, nose, and throat (ENT) specialists, ophthalmologists, and other experts, depending on the surgical approach.

“Special monitoring teams help track nerve function throughout surgery, even while the patient is under anesthesia, ensuring that functions such as hearing, swallowing, and eye movement remain protected,” Lopez-Gonzalez said.

More than tumors

While tumors account for most skull base procedures, they are not the only reason patients may need this type of surgery. Other conditions can include:

• Brain aneurysms

• Vascular malformations

• Cavernomas

• Congenital abnormalities such as Chiari malformation

• Certain chronic pain disorders

In some situations, doctors may recommend monitoring rather than immediate surgery if a lesion is small and not causing symptoms.

What recovery looks like

Recovery varies depending on the size and complexity of the condition. Minimally invasive procedures performed through the nose may allow discharge within a day, while more complex operations require longer hospital stays.

Surgical times can range from three to four hours for smaller tumors to 12–20 hours for highly complex cases, sometimes performed in multiple stages.

When to get checked for a potential tumor

Symptoms that are new or unusual could be potential warning signs that should be examined by a doctor. Lopez-Gonzalez says various signs may include: 

• A sudden or new type of headache

• Changes in an existing headache pattern

• Persistent vomiting associated with headaches

• Seizures

• Balance problems

• Neurological changes that feel out of the ordinary

“If someone is living a normal life and suddenly something changes, that’s when we need to look into it,” Lopez-Gonzales says. 

Patients experiencing new or concerning symptoms should consult their primary care provider or seek medical evaluation, which may lead to imaging studies if needed.

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