One of the most common entities are meningiomas, which can develop along the entire base of the skull. Starting from the sphenoid wing or the rhinobasis, these can grow into the cavernous sinus, for example, but also into the optic canal, the orbit, or the paranasal sinuses, leading to blindness in patients. The aim of surgical resection is to remove the tumor and relieve pressure on the affected nerves, if necessary via an intra- and extradural approach with relief of the orbit, optic canal, and nerves running in the base, followed by complex coverage. In selected cases, resection is performed transcranially and transnasally in a joint operation together with colleagues from ENT or maxillofacial surgery.
Other tumors develop directly from Schwann cells that surround the cranial nerves, e.g., acoustic neuromas (vestibular schwannomas) or neurinomas of other nerves (e.g., facial neurinomas, trigeminal neurinomas, neurinomas of the caudal cranial nerves). With the aid of neuromonitoring, the nerve fibers can be detected and the tumor can be gently resected while preserving nerve function. Particular attention is paid, for example, to preserving the function of the facial nerve and hearing in acoustic neuromas. In addition to classic neuromonitoring, we currently use brainstem electrodes to derive the potentials of the auditory function even more accurately. The latest microscopes (Kinevo™, Zeiss) with integrated endoscopy function also allow us to see into angles that are not directly visible, e.g., into the milled internal auditory canal.

A special feature of skull base surgery at our center is the surgical removal of tumors or vascular malformations (cavernomas) within the orbit via orbital or transcranial approaches. In addition, vascular pathologies in the skull base region are treated, including vascular compressions such as trigeminal neuralgia or dynamic circulatory disorders associated with Bowhunter syndrome. In selected cases, microsurgical decompression or vascular reconstruction procedures may be necessary.

In order to safely and gently remove tumors of the anterior and, above all, middle skull base, we have established fully endoscopic transnasal approaches in addition to the established transfacial approaches, in collaboration with our colleagues in ENT. Navigation-guided surgery is used to remove tumors in the area of the rhinobasis, sella, and clivus, some of which have penetrated the dura and grown from the base far into the intracranial space. These are often meningiomas, carcinomas, esthesioneuroblastomas, and, above all, chordomas, chondrosarcomas, or other sarcomas.

In the treatment of these sometimes very rare tumors, our center stands out thanks to its many years of experience and intensive collaboration with colleagues in radiation oncology and the Heidelberg Heavy Ion Center (HIT).

Access methods and techniques have changed considerably in order to make resection safe and gentle. Extensive and invasive transfacial access through the midface has been supplemented by endoscopic endonasal access. This requires the consistent use of modern technology, such as neuronavigation, intraoperative imaging with CT and MRI, neuromonitoring of nerve function, and a modern endoscopy system with high-resolution 4K monitors or state-of-the-art microscopes with navigation connection, endoscopy function, and ICG angiography. Thanks to our consistent interdisciplinary approach to skull base surgery, we are always able to develop a surgical concept tailored to the individual situation.