At the Skull Base Center of Heidelberg University Hospital, both benign and malignant conditions of the skull base are treated through an interdisciplinary approach. These include tumors and other disorders that originate directly at the skull base or affect its structures. Typical conditions we treat include:

• Tumors of the pituitary gland (hypophysis), such as pituitary adenomas and craniopharyngiomas
• Benign tumors of the meninges, so-called meningiomas, occurring at the anterior, middle, or posterior skull base
• Benign tumors of the vestibular nerve, known as vestibular schwannomas (also called acoustic neuromas)
• Rare malignant tumors, such as chordomas or sarcomatous tumors of the skull base
• Tumors of the nasal cavity and paranasal sinuses that may infiltrate the skull base, including squamous cell carcinoma, adenoid cystic carcinoma, and olfactory neuroblastoma
• Diseases of the temporal bone, e.g. cholesteatomas extending toward the skull base
• Tumors of the eye socket (orbit)
• Rare skull base tumors, such as glomus tumors and vascular anomalies
• Inflammatory processes, such as osteomyelitis or osteoradionecrosis of the skull base
• Skull base injuries, e.g. after accidents or as a result of previous treatments
• Malformations of the skull base as well as spontaneous or post-therapeutic cerebrospinal fluid leaks (rhinorrhea or otorrhea)

Thanks to the close collaboration between the departments of Neurosurgery, Otorhinolaryngology (ENT), Oral and Maxillofacial Surgery, and Radiation Oncology, we provide comprehensive, specialized diagnostics and therapy from a single source. Depending on the condition, we develop an individualized treatment plan – ranging from surgical procedures and radiation or chemotherapy to combined, innovative therapeutic approaches.

Skull base tumors are a diverse group of neoplasms that develop in the complex region at the base of the skull—where the brain rests and numerous important nerves and blood vessels pass through. These tumors can be benign or malignant and may originate from different tissues such as bone, nerves, or glands. Because of their proximity to vital structures, even benign tumors can cause significant symptoms and therefore require specialized treatment.

Common Types of Skull Base Tumors

Meningiomas:
The most common benign tumors of the skull base, meningiomas arise from the meninges, the membranes covering the brain and spinal cord. Although they are benign, they may grow large enough to compress surrounding structures and cause various neurological symptoms.

Pituitary Adenomas:
These tumors develop in the pituitary gland, located at the skull base. They are usually benign but can cause hormonal disorders, visual disturbances, or pressure symptoms due to their location close to the optic nerves and other critical structures.

Vestibular Schwannomas (Acoustic Neuromas):
Benign tumors that arise from Schwann cells surrounding the vestibular nerve, which connects the inner ear to the brain. Typical symptoms include hearing loss, tinnitus (ringing in the ear), and balance problems.

Chordomas:
Rare malignant tumors that originate from remnants of the notochord, a structure important in early spinal development. Chordomas grow slowly but can destroy surrounding bone and soft tissue.

Sinonasal Carcinomas:
Malignant tumors that arise in the nasal cavity or paranasal sinuses and may extend into the skull base. Typical symptoms include nasal obstruction, facial pain, and swelling.

Symptoms

The symptoms of skull base tumors vary depending on their size, location, and type. Common symptoms include:

• Severe, persistent headaches
• Visual disturbances (double vision, vision loss)
• Hearing loss or tinnitus
• Balance or coordination problems
• Numbness or weakness in the face
• Hormonal disorders (e.g., with pituitary adenomas)

Because these tumors can compress critical structures such as cranial nerves or the brainstem, early diagnosis is essential to prevent permanent neurological damage.

Treatment Options

Treatment depends on the type, location, and size of the tumor as well as the patient’s overall health. Common approaches include:

Surgical Removal:
For most skull base tumors, surgery is the primary treatment option. Minimally invasive techniques, such as endoscopic or microscopic surgery, allow access to the tumor while minimizing damage to surrounding tissue. The use of modern tools such as surgical navigation and intraoperative imaging increases the safety and precision of these procedures.

Radiation Therapy:
Often used for inoperable tumors or as an adjunct to surgery. Techniques such as stereotactic radiosurgery (e.g., Gamma Knife) allow for high-dose irradiation of the tumor while sparing healthy tissue.

Chemotherapy:
Less commonly used, but may be appropriate for certain malignant skull base tumors, particularly aggressive or metastatic types.

Observation:
In some cases—especially with small, benign tumors that cause no symptoms—close monitoring with regular imaging may be the best approach.

Conclusion

Skull base tumors represent a complex medical challenge due to their location and potential impact on vital structures. Early diagnosis and an interdisciplinary approach involving neurosurgeons, ENT specialists, and oncologists are crucial to achieving the best possible treatment and prognosis.

Comprehensive and interdisciplinary skull base surgery is a highly specialized field within neurosurgery and otorhinolaryngology (ENT), requiring close collaboration across multiple medical disciplines. The complex anatomy of the skull base, which contains numerous vital neurovascular structures, demands a deep understanding of anatomy, precise surgical planning, and the use of modern technologies to ensure maximum safety and effectiveness.

In recent years, technological advances have significantly transformed skull base surgery, particularly through the integration of navigation systems and intraoperative imaging. These innovations have improved the accuracy of tumor removal, reduced complications, and greatly enhanced treatment outcomes for patients.

Navigation systems, often compared to a GPS for the human body, have become indispensable in skull base surgery. They allow surgeons to map a patient’s anatomy in detail prior to surgery using high-resolution imaging techniques such as CT and MRI. During the procedure, the navigation system tracks the position of surgical instruments in real time and continuously matches them with preoperative imaging data. This is especially crucial in skull base surgery, where millimeter-level precision is required to avoid injury to surrounding structures such as cranial nerves, blood vessels, or the brainstem.

The integration of intraoperative imaging further enhances surgical precision. Techniques such as intraoperative CT or MRI provide real-time imaging during surgery. This is particularly valuable for assessing the extent of tumor resection and immediately identifying and removing any remaining tumor tissue. By providing up-to-date images during the procedure, the risk of leaving behind residual tumor tissue that is difficult to detect with conventional visual inspection is minimized. In addition, intraoperative imaging facilitates navigation in cases of complex anatomical variations and helps verify critical surgical steps, such as the integrity of the dura mater or the completeness of skull base reconstruction.

Another modern technique is the use of 3D modeling and 3D printing. Patient-specific models of the skull base can be created before surgery, supporting precise surgical planning and enabling surgeons to simulate complex procedures in advance, better anticipating potential challenges.

The success of skull base surgery relies heavily on interdisciplinary collaboration. Neurosurgeons, ENT specialists, radiologists, and in some cases plastic surgeons work hand in hand, combining their expertise—particularly in the treatment of complex tumors, vascular malformations, or trauma affecting the skull base.

Conclusion
Modern technologies, especially navigation systems and intraoperative imaging, have revolutionized skull base surgery. Today, they enable more precise, safer, and more effective procedures. The future of skull base surgery lies in continued technological innovation and in the advancement of minimally invasive and highly precise surgical techniques.