Skull Base Surgery
The skull base is the complex region at the base of the skull. Many conditions here can now be treated through the nose with an endoscope, without cuts on the face or head. Care is provided with a team that includes a skull base surgeon.
Pituitary adenoma
A non-cancerous tumour of the pituitary gland, which can affect hormone production or press on nearby nerves. Symptoms include headache, vision problems, and hormone effects such as milk discharge, irregular periods or acromegaly.
- Tests: MRI and CT scans to assess size, position and the surgical approach; hormone blood tests such as prolactin and growth hormone; and an eye examination for visual field defects
- Treatment: endoscopic transsphenoidal surgery through the nose; medicines for some hormone-producing tumours; radiotherapy for tumours that cannot be fully removed
CSF leak from the nose (CSF rhinorrhoea)
Cerebrospinal fluid (CSF) surrounds the brain. When it leaks through a defect in the skull base into the nose, it causes a clear, watery nasal discharge. Leaks can come from one site or several.
- Tests: CT scan and MR cisternography to locate the leak; beta-2 transferrin test to confirm the fluid is CSF; intrathecal fluorescein dye during surgery in selected cases
- Treatment: bed rest, stool softeners and medicines at first; endoscopic repair if the leak continues; a lumbar drain for a short period when CSF pressure is high
Facial nerve weakness after injury
A fracture of the temporal bone can press on the facial nerve and cause partial or complete facial paralysis. Decompression surgery relieves the pressure to help the nerve recover.
- Tests: HRCT of the temporal bone to look for bone pressing on the nerve; nerve studies (EMG) to judge the extent of injury and timing of surgery
- Treatment: steroids and physiotherapy; surgery when bone is pressing on the nerve, the nerve is cut, or there is no recovery with medical treatment
Labyrinthectomy for severe vertigo
For severe, disabling vertigo that has not responded to any other treatment, the balance organ of the inner ear can be deactivated, either with gentamicin injections into the ear or by surgery. Both can cause permanent hearing loss in that ear, so this is considered only after careful discussion. Read more about vertigo.
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