•

• Behavioral Neurology
• Epilepsy
• Glossary of Terms
• Head and Spinal Cord Trauma
• Minimally Invasive Surgery
• Movement Disorders and Pain
• Neuroimmunology
• Neuromuscular Diseases
• Neuro-oncology
• Pediatric Neurosurgery
• Skull Base Surgery
• Spine
• Stroke and Cerebrovascular Disease
Skull Base Surgery Overview
• Skull Base Surgery Overview
• Acoustic Neuromas, Neuro-Oncology
• Arachnoid Cysts
• Cavernous Sinus, tumors and aneurysms of
• Chordomas and Chondrosarcomas, neuro-oncology
• Clival Tumors
• Epidermoid and Dermoid Tumors, neuro-oncology
• Glomus Jugulare Tumors
• Meningiomas, neuro-oncology
• Olfactory Groove and Sphenoid Wing Meningiomas
• Trigeminal neuralgia
Skull base surgery refers to surgical techniques required to obtain access to the floor of the
cranial cavity. Due to the complexity of this region, this type of surgery is one of the more
challenging procedures for a neurosurgeon to perform. The neurosurgeon often works in
conjunction with ear,nose, and throat or plastic surgeons when performing skull base surgery
because of the close proximity of the face and neck to the skull base.
Anatomy of the skull base
The skull base is a complex irregular bone surface on which the brain rests. Contained within
this region are major blood vessels that supply the brain with essential nutrients and important
nerves with their exiting pathways. The floor of the skull is divided into three regions from front
to back: the anterior, the middle, and the posterior compartments. The anterior compartment is
the region above a person's eyes, the middle compartment is the region behind the eyes and
centered around the pituitary gland, an organ required for proper hormonal function.
The posterior compartment contains the brainstem and the cerebellum. The brainstem is the
connection between the brain and spinal cord, containing the origin of nerves involved in the
control of breathing, blood pressure, eye movements, swallowing, etc. This connection occurs
through the large hole, known as the foramen magnum, within the center of the posterior
compartment. The cerebellum, lying behind the foramen magnum, is involved with coordination
and balance. The roof of the skull base is composed of the brain itself and a thick sheet of tissue
on which the brain rests, called the tentorium. Adding to the complexity of this region is the fact
that each compartment of the skull base is at a different level. The anterior compartment is
highest and the posterior compartment lowest, when a person is standing and looking forward.
Symptoms of skull base disorders
The presentation of patients with diseases of the skull base is highly variable because of the
many important structures contained in this area. These symptoms occur due to compression on
important nerves or by blocking the normal flow of fluid around the brain. Various symptoms are
specified to the compartment involved.
• Diseases of the anterior compartment may produce headache, sinus congestion, or vision
changes.
• Those of the middle compartment may produce derangements of endocrine function or
vision changes
• Those of the posterior compartment produce neck pain, dizziness, tinnitus, hearing loss,
and difficulties with swallowing and talking.
Surgery for skull base disorders
The main indication for skull base surgery is the removal of various brain tumors which may
occur within this area. The diversity of these tumors is vast, and they may arise from various
sources including the brain, the lining of the brain, the bones making up the skull base, or
metastases. Although these tumors have unique individual characteristics, they may present in a
similar fashion due to involvement of similar nervous structures. They can be grouped according
to the area of the skull base from which they arise:
• Tumors occurring in the anterior compartment (also see the orbital tumors page) include
meningiomas, estheisoneuroblastomas, orbital gliomas, and nasopharyngeal carcinomas.
• Those occurring in the middle compartment include meningiomas, pituitary adenomas,
craniopharyngiomas, and schwannomas.
• Those of the posterior compartment include brainstem gliomas, acoustic neuromas,
cerebellar astrocytomas, ependymomas, medulloblastomas, hemangioblastomas,
epidermoid tumors, chordomas, chondrosarcomas, and metastases.
The occurrence of these tumors varies with the age of the patient, his or her medical history, and
family history.
In addition to removing tumors, skull base surgery also provides access to various aneurysms
occurring within this region. An aneurysm is an abnormal dilatations of a blood vessel. Vessels
included at the skull base are the internal carotid, ophthalmic, basilar arteries and the cavernous
venous sinus.
Due to the complexity of skull base surgery, these procedures are best performed at a tertiary
care facility where there is adequate ancillary services available to the neurosurgeon in the
management of these patients. Both operative and post-operative care requires expertise not only
in the area of neurosurgery but also in the areas of neurophysiology, neurology, neurological
oncology, radiation oncology, and intensive care nursing. Phrases used to describe skull base
surgery designate the approach the neurosurgeon uses and include midline, paramedian, and
extreme far lateral suboccipital, presigmoid, subfrontal, and Dolenc.
Diseases of the skull base were at one time linked to a poor prognosis. Advances in
microsurgical techniques, an increased understanding of both the skull base anatomy and
behavior of these disease processes, and improvements in neuroimaging have allowed such
lesions to be successfully treated.
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Request an Appointment Online.
Phone
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Office Hours
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 •
• Behavioral Neurology
• Epilepsy
• Glossary of Terms
• Head and Spinal Cord Trauma
• Minimally Invasive Surgery
• Movement Disorders and Pain
• Neuroimmunology
• Neuromuscular Diseases
• Neuro-oncology
• Pediatric Neurosurgery
• Skull Base Surgery
• Spine
• Stroke and Cerebrovascular Disease
Epidermoid and Dermoid Tumors
• Neuro-Oncology Overview
• Acoustic Neuromas, Neuro-Oncology
• Anaplastic Astrocytomas
• Astrocytomas
• Brain Tumors
• Chordomas and Chondrosarcomas
• Ependymomas
• Epidermoid and Dermoid Tumors
• Esthesioneuroblastoma (ENB)
• GMB (Glioblastoma multiforme)
• Gliomas/Astrocytomas
• Hemangioblastomas
• Intraventricular Tumors
• Meningiomas
• Metastatic Brain Tumors
• Mixed Gliomas
• Oligodendrogliomas
• Orbital Tumors
• Posterior Fossa Tumors
• Skull Base Tumors
 • Spinal Meningiomas
• Spinal Tumors
Epidermoid and dermoid tumors are slow-growing benign tumors that result from a
developmental abnormality. These rare tumors occur when a certain kind of tissue in an embryo,
called ectodermal tissue, becomes misplaced in the developing brain. This causes the formation
of a fluid-filled cyst, called an ectodermal inclusion cyst, that makes up the tumor. Epidermoid
tumors comprise one percent of brain tumors, and dermoid tumors just 0.3 percent. These tumors
also are referred to as germ cell tumors because the ectodermal tissue is known as a germ layer.
Cyst characteristics and location distinguish epidermoid and dermoid tumors. Epidermoid tumors
usually are located on the side of the brain or skull, while dermoid tumors are located closer to
the brain's midline. The cysts of dermoid tumors include other dermal components, such as the
material that makes up hair, teeth, and skin glands, while epidermoid tumors do not. Fifty
percent of those with dermoid tumors will have other congenital abnormalities, while those with
epidermoid tumors do not. These tumors can occur in a variety of locations, including the spine,
skull, scalp, and inside the brain (intracranially).
Unlike most epidermoid and dermoid cysts, which occur spontaneously during development,
spinal ectodermal inclusion cysts are caused by the displacement of skin tissue following a
lumbar puncture or spinal tap, a procedure used to extract cerebrospinal fluid from the lower
spine. This is a rare occurrence after a lumbar puncture, which is an extremely safe procedure.
Symptoms
The symptoms of epidermoid and dermoid tumors vary depending on their location. Cysts on the
scalp and skull usually are painless, mobile, rubbery masses. Usually they only cause cosmetic
problems, although cysts on the skull may penetrate into the brain. Depending on specific
location, intracranial tumors may cause visual problems, seizures, pain in the face, numbness, or
weakness. If the cysts rupture and spill their contents, they can cause repeated bouts of severe
meningitis, with symptoms including fever, headache, and neck stiffness.
Diagnosis
Imaging studies are the key component in the diagnosis of epidermoid and dermoid brain tumors.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used. However,
the agents usually used to distinguish tumors from normal tissue in the background do not
provide contrast in ectodermal inclusion cysts, so the tumors may be indistinct.
Treatment
Chemotherapy and radiation have no effect in the treatment of these tumors, so surgical removal
is the only treatment option. The removal must include the entire cyst-both the contents and the
lining-and the more complete the resection, the less likely the cyst is to return. The primary
concern of surgical resection is to ensure that the contents of the cyst do not spill out to irritate
the brain and cause meningitis.
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Search

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Contact Us
For your convenience, we offer several options for scheduling an appointment.
Request an Appointment Online.
Phone
(866) 426-7787
(212) 746-4684
Office Hours
Monday - Friday, 9:00 AM to 5:00 PM
Emergency Department,
NewYork-Presbyterian/Weill Cornell

(212) 746-5026

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