SKULL BASE SURGERY

The skull consists of bones and cartilage that form the face and the cranium that encircles the brain.  The skull base is an , intricate region with numerous openings through which the spinal cord, blood vessels, and cranial nerves pass through.  It is the base, upon which the brain rests. Skull base surgery is predominantly performed to remove a tumour that is attached to the skull base. The difficulty of skull base surgery is accessing these areas without cutting through the skull and retracting the brain. The objective is to reach and operate on these problematic areas with minimal disturbance on the brain.   Thankfully with modern minimally invasive skull base access techniques, tumours in this are can be reached with very minimal brain disturbance.

WHEN IS SKULL BASE SURGERY NECESSARY?

Skull base surgery is performed for the treatment of a variety of abnormalities and tumours. These abnormalities can include tumours such as meningioma, chordoma or craniopharyngioma, cysts that develop from birth, trigeminal neuralgia, and cerebral aneurysm surgery.

HOW IS SKULL BASE SURGERY DONE?

Following consultation with Professor Profyris and his team in Johannesburg, South Africa, a detailed plan that is customised to your specific tumour will be made.   Various imaging technologies such as CT, MRI, MRA/MRV and/or angiography will be used to plan your surgical approach meticulously. Although the skull base was historically difficult to access, advancement in our understanding of anatomy and the use of medical technology has led to the development of eloquent surgical approaches to address pathology in this region.  Depending on the pathology and on the exact location, Professor Profyris will use either a microscope, an exoscope or an endoscope  in order to address the lesion.  Often, Professor Profyris uses a combination of these visualisation technologies in order to address a particular pathology.  In Johannesburg, Professor Profyris and his team have developed particular expertise in the keyhole and minimally invasive procedures available to treat abnormalities and tumours of the skull base.

VESTIBULAR SCHWANNOMA (ACCOUSTIC NEUROMA)

This is a case of a vestibular schwannoma (acoustic neuroma) operated on by Professor Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the vestibular schwannoma which has been removed as can be seen by the images on the right.  This patient did not suffer any facial nerve weakness.

The green arrows on the left hand images demonstrate the giant acoustic neuroma which has been removed as can be seen by the images on the right. This patient presented with multiple problems due to the giant size of the tumour. These symptoms have successfully resolved.

CRANIOPHARYNGIOMA

This is a case of a large craniopharyngioma operated on by Professor Profyris.  The green arrows on the left hand images demonstrate the craniopharyngioma which has been removed as can be seen by the images on the right. The video demonstrates intraoperative endoscopic resection of the craniopharyngioma.

EPIDERMOID

This is a case of a large epidermoid operated on by Professor Profyris.  The green arrows on the left hand images demonstrate the epidermoid which has been removed as can be seen by the images on the right. The video demonstrates intraoperative endoscopic resection of the epidermoid.

MENINGIOMA

This is a case of a giant meningioma (position: olfactory groove) operated on by Professor Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery.  Below the scans we can see a reconstructed animation of this patients tumour demonstrating the tumour in penk and the optic nerves in orange.  This permits careful preoperative study of the tumour and assists with planning.

Another case of a meningioma (Position: Cerebello-Pontine Angle/Posterior Fossa) operated on by Professor Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery

Another case of a meningioma (Position: Sphenoid Wing) operated on by Professor Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery.

Another case of a meningioma (Position: Foramen Magnum) operated on by Professor Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery

This is a case of a meningioma causing progressive visual blindness(Position: Tuberculum Sellae) operated on by Professor Profyris through a keyhole extended endoscopic endonasal approach (EEA) through the nose.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  Vision recovered in this patient.

Above we can see a reconstructed animation of this patients tumour demonstrating the tumour in red and the optic nerves in orange.  This permits careful preoperative study of the tumour and assists with planning.

The video shows endoscopic intra-operative footage from a tuberculum sellae meningioma resection by Professor Profyris.

TRANSORBITAL SURGERY

This is a case of a cavernous sinus meningioma tumour operated on by Professor Profyris through a keyhole tranorbital neuroendoscopic approach (TONES).  The green arrows on the left hand images demonstrate the cavernnous sinus meningioma tumour which has been removed, as can be seen by the images on the right.  After meticulous study of the pre-operative imaging a transorbital neuroendoscopic approach was elected in order to avoid any injury to the brains temporal lobe, which was “in the way.” Recovery was uneventful.  The video below shows the endoscopic intra-operative footage from removal of this tumour.

This is a case of a cavernous sinus epidermoid operated on by Professor Profyris through a keyhole tranorbital neuroendoscopic approach (TONES).  The green arrows on the left hand images demonstrate the cavernnous sinus epidermoid which has been removed, as can be seen by the images on the right.  After meticulous study of the pre-operative imaging a transorbital neuroendoscopic approach was elected in order to avoid any injury to the brains temporal lobe, which was “in the way.”

This is a case of sphenoid wing meningioma causing pressure on they eyeball.  The eyeball was protruding and vision was being compromised.  This case was operated upon by Professor Profyris through a keyhole transorbital Neuroendoscopic (TONES) Approach.  The green arrows on the left hand images demonstrate the tumour causing significant orbital wall thickening and compression which has been removed, as can be seen by the images on the right.