What are the types of skull base surgery?

Endoscopic endonasal surgery through the nose; open craniofacial resection through the scalp and face; lateral approaches through and around the ear and infratemporal fossa; and combined approaches that use more than one route. The choice depends on the location and extent of the tumour.

What are the risks of skull base surgery?

Cerebrospinal fluid leak, infection or meningitis, bleeding, injury to cranial nerves causing visual, facial, hearing or swallowing problems, and hormonal disturbance after pituitary surgery. A trained team, navigation, nerve monitoring and careful reconstruction keep these risks as low as possible, and they are discussed in detail before surgery.

How long is the hospital stay after skull base surgery?

Three to five days for endoscopic surgery and seven to ten days for open or lateral approaches, with a short period in a monitored unit after major procedures.

Are skull base tumours cancerous?

Many are benign, including pituitary adenomas, meningiomas and angiofibromas. Others, such as sinonasal cancers, olfactory neuroblastoma and chordoma, are malignant and need oncological surgery with margins and, often, radiotherapy afterwards.

Will I need radiotherapy after skull base surgery?

Not for completely removed benign tumours. Radiotherapy or radiosurgery is recommended for most skull base cancers, for aggressive or incompletely removed benign tumours, and for tumours that regrow.

Why does the surgeon's training matter so much?

The skull base contains more critical structures per centimetre than any other part of the body, and safe surgery depends on detailed anatomical knowledge, familiarity with all approaches and the judgement to choose between them. Fellowship training and a multidisciplinary team are the best predictors of good outcomes.

Skull Base Surgery in Ahmedabad

Skull base surgery in Ahmedabad: safe, precise surgery for tumours at the base of the skull.

Skull base surgery treats growths at the base of the skull that were once considered inoperable. Advances in endoscopes, navigation and microsurgical technique now allow these tumours to be removed with far less disruption. Dr. Parin Patel selects the safest approach for each patient, through the nose, the ear or a carefully planned open route, with function preservation as the guiding principle.

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Specialist care
Clear decisions
Function-conscious planning

What is skull base surgery?

The skull base is the floor of the cranial cavity: a complex, irregular shelf of bone that supports the brain and separates it from the eyes, nose, sinuses, ears and upper neck. Every nerve leaving the brain and every major artery entering it passes through an opening in this bone. Skull base surgery is the specialty of operating on tumours and other lesions in and around this region, where millimetres separate the target from the optic nerve, the carotid artery, the facial nerve or the brainstem.

It is inherently a team discipline. Dr. Parin Patel, as a head, neck and skull base surgical oncologist, works alongside neurosurgery, ophthalmology, radiology and radiation oncology at HCG Aastha Cancer Centre so that each patient's operation is planned by all the specialties the anatomy demands.

The three regions of the skull base

Anterior skull baseAbove the nose and sinuses, below the frontal lobes. Home to olfactory neuroblastoma, sinonasal cancers that extend upwards, meningiomas and CSF leaks. Often reached endoscopically through the nose.

Central skull baseThe sphenoid bone, sella and clivus. Pituitary adenomas, craniopharyngiomas, chordomas and nasopharyngeal cancers arise here. The endonasal corridor gives direct midline access.

Lateral skull baseThe temporal bone around the ear and the infratemporal fossa below it. Glomus tumours, deep parotid tumours, advanced cheek cancers and lateral meningiomas are reached through open approaches beside or through the ear.

Conditions treated with skull base surgery

Pituitary adenomas and other sellar lesions
Paranasal sinus and sinonasal cancers reaching the orbit or skull base
Olfactory neuroblastoma (esthesioneuroblastoma)
Meningiomas of the anterior and lateral skull base
Chordomas and chondrosarcomas of the clivus
Juvenile nasopharyngeal angiofibroma
Advanced oral and parotid cancers invading the infratemporal fossa, treated by compartment clearance
Cerebrospinal fluid leaks and encephaloceles
Recurrent nasopharyngeal cancer after radiotherapy

Symptoms that may indicate a skull base tumour

Symptoms depend on which nerves and structures the tumour is affecting, and are frequently subtle at first:

Persistent one-sided nasal blockage, discharge, nosebleeds or loss of smell
Visual loss, double vision, or a bulging or displaced eye
Facial numbness, facial pain or facial weakness
One-sided hearing loss, ringing or pulsing sound in the ear, or dizziness
Difficulty swallowing, hoarseness or a weak shoulder from lower cranial nerve involvement
Headache that is new and progressive
Hormonal disturbance from pituitary involvement
Clear fluid leaking from the nose

Approaches to the skull base

The single most important decision in skull base surgery is the route. Dr. Patel is trained in the full range of approaches and chooses the one that reaches the tumour with the least disturbance to healthy structures.

Endoscopic endonasal surgery

Through the nostrils, without any external incision, for midline tumours of the anterior and central skull base. Described in full on our endoscopic skull base surgery page. Recovery is fastest with this approach, and it is now the standard for pituitary tumours and many sinonasal tumours.

Open craniofacial resection

For large anterior skull base cancers that involve the skin, orbit or frontal lobes, a combined approach through a scalp incision (craniotomy) and the face allows the tumour, the involved bone and the dura to be removed together. The defect is reconstructed with a pericranial flap or a free flap. Increasingly, an endoscopic approach from below is combined with a smaller craniotomy from above, reducing the size of the facial incisions. See also craniofacial surgery.

Lateral and infratemporal fossa approaches

Tumours of the temporal bone, jugular foramen and infratemporal fossa are reached through incisions around the ear and upper neck, with the facial nerve identified and protected, and sometimes rerouted. Compartment clearance of the infratemporal fossa for advanced oral and cheek cancers, a technique for which Dr. Patel received the FHNO gold medal in 2018, belongs to this family.

Reconstruction

Every skull base resection ends with a watertight separation of the brain from the nose and throat, using vascularised local flaps or microvascular free flaps, and restoration of facial contour and function. This is covered on our reconstructive surgery page.

Why Dr. Parin Patel

Skull Base Surgery Fellowship at Tata Memorial Centre, Mumbai (2021–22)
Fellowship in Head and Neck Oncology and more than thirteen years of surgical experience
Competence in endoscopic, open and combined approaches, so the choice is made purely on safety and completeness
Multidisciplinary skull base team with neurosurgery, ophthalmology, radiology and radiation oncology at HCG Aastha Cancer Centre
Oncological training that ensures cancers are removed with proper margins, not merely debulked

The skull base surgeon page explains why fellowship training matters in this field, and the about page covers Dr. Patel's career.

Recovery after skull base surgery

Recovery depends on the approach. After endoscopic surgery, most patients go home in three to five days and return to work in two to three weeks. After open craniofacial or lateral approaches, the hospital stay is typically seven to ten days, with a period of monitoring in a high-dependency unit, and full recovery takes six to eight weeks. Nasal care, eye protection when facial nerve function is temporarily reduced, swallowing assessment when lower cranial nerves are involved and hormone monitoring after pituitary surgery are all part of the plan. Radiotherapy, when needed, begins once healing is complete. Our rehabilitation team supports recovery of any affected function.

Endoscopic skull base surgeryThe through-the-nose approach in detail.Skull base surgeonTraining, team and case selection.Pituitary tumour surgeryEndonasal pituitary adenoma removal.Paranasal sinus cancerSinonasal tumours reaching the skull base.Craniofacial surgeryOpen resection and facial reconstruction.Book a consultationBring your MRI and CT scans.

Patient questions

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