craniofacial

Craniofacial & Skull Base Tumours

What are Craniofacial Skull Base Tumours?

Craniofacial & skull base tumours are abnormal growths that occur at the junction of the skull and face, particularly in the base of the skull where it interfaces with facial structures. These tumours can be benign (non-cancerous) or malignant (cancerous) and may arise from bone, nerve tissue, glandular tissue, or connective tissue. Because of the critical anatomical location, these tumours can significantly impact neurological and facial functions.

The Procedure

How is it Diagnosed?

Diagnosis involves a combination of clinical evaluation, imaging, and sometimes biopsy. Symptoms depend on tumour location and size, and may include headaches, vision or hearing loss, facial pain or numbness, nasal obstruction, or cranial nerve deficits.

MRI scans are essential for soft tissue characterization and evaluating the tumour’s relationship with the brain and cranial nerves.
CT scans provide detailed images of bone involvement and structural changes in the skull base.
Angiography may be used to assess blood vessel involvement.
Biopsy is often performed to determine the histological type of tumour, guiding treatment decisions.
Endoscopy may be used for visualizing tumours in the nasal or sinus region.

What Are the Causes?

The causes of craniofacial skull base tumours vary depending on the tumour type:

Genetic conditions like neurofibromatosis and tuberous sclerosis can predispose individuals to certain skull base tumours.
Radiation exposure may increase the risk of some types of skull base tumours.
Congenital abnormalities or developmental anomalies may contribute to tumour formation in children.
Many cases are sporadic, with no known cause.

What Are the Implications?

Due to their complex location, craniofacial skull base tumours can have serious implications:

Neurological impairment from compression or invasion of cranial nerves, resulting in visual, auditory, or facial motor/sensory deficits.
Intracranial pressure increases due to tumour growth.
Facial disfigurement or deformity, especially with larger or aggressive tumours.
Airway or nasal obstruction, impacting breathing and sinus drainage.
Cognitive or psychological effects due to visible changes or neurological symptoms.

In malignant cases, there is a risk of local invasion, recurrence, and metastasis.

What Are the Treatment Options?

Treatment depends on the tumour’s type, size, location, and the patient’s overall health.

Surgical resection is often the primary treatment, aiming for complete removal while preserving critical structures. Skull base surgery is highly specialized and often performed by a multidisciplinary team including neurosurgeons, ENT surgeons, and plastic surgeons.
Minimally invasive techniques, such as endoscopic endonasal approaches, are increasingly used for selected tumours, reducing recovery time and scarring.
Radiotherapy, including stereotactic radiosurgery (e.g., Gamma Knife), may be used as a primary treatment for inoperable tumours or as an adjunct after surgery.
Chemotherapy is used for certain tumour types, particularly malignant or aggressive variants.
Reconstructive surgery may be necessary to restore facial structure and function after tumour removal.

Long-term follow-up with imaging and clinical exams is essential to monitor for recurrence and manage any residual functional deficits. A multidisciplinary approach ensures optimal treatment outcomes and quality of life for affected patients.