Skull base

Skull base

We are specialists in endoscopic surgery of skull base, technique with which it is possible to treat localized pathologies throughout the base of the skull, accessing only through the natural corridor that form the nostrils. Our team is a pioneer in the country in this superspeciality that has revolutionized the classic neurosurgical concepts.

Although applicable to a broad spectrum of tumor, malformative and degenerative diseases, endonasal endoscopic neurosurgery techniques are currently the treatment of choice for pituitary adenomas, craniopharyngiomas and some meningiomas at the base of the skull.

This technique is only applied in certain reference hospitals in Spain. The “classic” neurosurgical approach to tumors of the skull base is performed from “inward”, usually reaching tumor injury through natural corridors in the brain, as opposed to the endoscopic approach, where the brain is either above or behind the tumor, favoring less manipulation of brain tissue.

The postoperative period of these patients is more comfortable in the absence of external injuries, and hospital stays are significantly shortened on other occasions.

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Pituitary adenoma

In the pituitary gland or pituitary can cause tumor processes that, although usually have a benign nature, can sometimes affect fundamental structures such as carotid arteries or optic nerves. Patients with this type of lesion should be previously evaluated by the Endocrinologist, who prescribes the corresponding hormonal study for the preoperative assessment of the patient.

Description

The pituitary adenoma is a benign tumor originated in the pituitary gland (hypophysis), regulating center of the hormonal function of our organism.

Pituitary tumors can be classified into two major subtypes, functioning (producing hormones) and non-functioning.

The patient will manifest a symptomatology of hormonal alterations in tumors that we call “functioning”, such as hyperproduction of the hormone prolactin (hyperprolactinemia), Cushing’s syndrome or acromegaly. Another reason for consultation is the visual alteration (bitemporal hemianopsia) dependent on the compression of the optic nerves by the tumor mass, mainly in those tumors that do not produce hormones, that is, “non-functioning”. In these patients, lateral visual fields are typically affected.

In some functioning tumors such as prolactinomas, the initial treatment is medical, with drugs such as cabergoline, which in many cases reduces and controls the tumor.

Treatment

Surgical treatment is indicated in those cases in which a tumor growth is demonstrated during the follow-up in consultations or those with endocrinological or optical pathway involvement.

Acoustic neuroma

Vestibular schwannoma, also known as acoustic neurinoma, represents a pathology that challenges the neurosurgeon because of the technical difficulty it offers in its surgical treatment. On the other hand, it must be taken into account that it has a benign nature, which implies that its evolution after a good surgical resection is very favorable.

Description

Our specialists have extensive experience in the management of these tumors, having obtained very satisfactory results in the operated patients.

The ACOUSTIC NEUROMA, also called vestibular schwannoma, is a tumor derived from the vestibular nerve sheaths of the ear, which is benign and usually has a slow growth.

It originates in the internal auditory canal, a bone channel that crosses the temporal bone (ear bone), and through which the vestibular nerves (responsible for balance), the cochlear nerve (nerve of hearing) and the facial nerve (responsible for the mobility of the face) run.

In the initial stages, the characteristic symptomatology of these tumors is otological, in the form of hearing loss (hearing loss), tinnitus (noise in the ears) and imbalance.

They are usually detected when performing imaging studies (magnetic resonance imaging) in patients who consult for these symptoms.

As the tumor volume increases, the neurinoma extends towards the cerebellopontine angle, an anatomic area where it can produce a progressive compression of the brainstem, a vital structure that connects the brain with the spinal cord.

Treatment

The neurosurgical treatment of neurinomas is technically complex and is carried out through a small approach behind the auricle, through which the tumor is accessed.

The goal of the surgery is to remove the tumor by fully preserving the facial nerve and hearing if the patient does not have an advanced hearing loss.

To ensure patient safety, we perform an intraoperative neurophysiological monitoring, through which Neurophysiology specialists collaborate with the neurosurgeon during the surgical procedure, detecting in advance the functional changes that may occur in the neurological structures related to surgery, which contributes high patient safety index.

In general, the postoperative period is very well tolerated by patients, and they can be discharged early.

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Cranial base meningioma

Meningiomas are tumors that originate from the cerebral envelopes, and can be located in any area of the nervous system.

Those implanted at the base of the skull (the “seat” of the brain) present a significant management difficulty, but nowadays they can be treated safely with the great technical contribution of endoscopic surgery through the nostrils, which allows the removal of complex tumor processes in a less aggressive way for the patient.

Description

Meningiomas are benign tumors derived from the envelopes of the nervous system (meninges and arachnoids). They can appear in any intracranial or spinal location, usually are slow growing and produce symptoms when they acquire large size or compromise structures that produce characteristic warning signs or symptoms.

The meningiomas that appear in the structures of the base of the skull represent one of the most complex tumor pathologies in terms of treatment in Neurosurgery, since in their growth progressively involve vital structures such as cerebral arteries and cranial nerves, so microsurgical dissection results technically of high complexity.

Treatment

The endonasal approach is a very useful tool in the management of some of these tumors, such as meningiomas of the sellar tubercle or the clivus, allowing an effective and safe micro-surgical dissection, since the approach is directly from the nasal passages to the base of implantation of the tumor in the cranial base, leaving the brain tissue above, which results in less manipulation of the brain.

Advanced nasosinusal ENT surgery

Surgery of the nose and sinuses was previously performed by external incisions on the face, which produced an obvious aesthetic defect and more prolonged and annoying postoperative. Fortunately today, most nasosinusal surgical diseases can be treated only by endoscopic techniques, using the natural nasal cavity corridor. Our team has carried out multiple interventions of this type, emphasizing as a reference unit in the pathology of frontal sinus and nasosinusal tumors.

Description

The paranasal sinuses are air cavities located in the facial bones, within which multiple pathologies of an infectious or tumoral nature can arise, for which endoscopic endoscopic surgery should be the treatment of choice today.

Our extensive experience in this type of techniques makes us a reference center for advanced otorhinolaryngological pathology such as cerebrospinal fluid fistulas, mucoceles and bone tumors of the frontal sinus (osteomas), nasosinus and skull-base tumors such as carcinomas, or esthesioneuroblastomas.

Treatment

Through endonasal endoscopic surgery, a radical extirpation of the lesion is carried out, with minimal repercussion in the postoperative period, which is comfortable for the patient, since no external wounds or bone mobilizations are performed.

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Craniopharyngiomas

The craniopharyngioma is a tumor located above the pituitary gland, and that in its growth can produce significant hormonal disorders. It also affects the optic nerves, so the therapeutic management of these tumors is the neurosurgical treatment, by which the objective of decompressing the optic pathways is achieved.

In Neurovist we are specialists in this type of pathologies, which intervene exclusively through endoscopic surgery through the nostrils.

Description

Craniopharyngioma is a tumor that originates from an embryonic remnant called the Rathke’s pouch, from which the pituitary gland originates. They are not considered malignant tumors, but they do pose a lot of difficulty when it comes to surgical treatment, since the recurrence rate is high.

Most of these tumors have mixed solid and cystic areas and usually harbor calcium content inside.

In therapeutic management, we collaborate closely with the endocrinologist, since craniopharyngioma can produce important hormonal alterations before and after the neurosurgical treatment.

Treatment

The treatment of choice at present is the endoscopic endonasal approach, which is performed only through the nostrils, and which allows the optimal visualization of the tumor with a correct microsurgical dissection of the vital structures affected by it.

 

Cerebrospinal fluid fistula

At Neurovist we are experts in the treatment of cerebrospinal fluid fistula, which consists of the loss of cerebrospinal fluid through the nostrils or the ear.

They can appear after traumatisms or idiopathically, ie without any notable antecedents. This pathology responds very well to the neurosurgical treatment, which is performed minimally invasively through the nostrils only.

How is the surgery?

In endoscopic neurosurgery of the lesions of the base of the skull, access is made only through the nostrils, through which we develop in the first time a working channel that will allow us to access with comfort to the specific anatomical area in which is the pathology. The tissues of the nostrils will also be used later in the closure of the defects that we have created in the cranial base. In the second time (neurosurgical), the lesion is accessed, performing a removal with microsurgical technique.

In this type of techniques we work together the otolaryngologist specialist with the neurosurgeon, working “four hands” through both nostrils, a circumstance that requires a collaboration and exquisite rapport between both specialists.

The postoperative period is generally well tolerated by patients. In many cases we place a nasal tamponade that is maintained for some days.