Tumors of the brain are caused by the growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancerous).

Cancerous tumors in the brain include tumors that spread to the brain from their site of origin in other organs. These are called metastatic tumors. When lung cancer, for example, spreads to the brain, it is called lung cancer that has metastasized to the brain.

The following are examples of the skull base tumors treated by the OSUCCC – James skull-base team and the methods used to treat the tumors.

Malignant tumors

Adenocarcinoma


A cancer that begins in glandular (secretory) cells. Glandular cells are found in tissue that line the mouth, salivary glands throat and nasal cavity and release substances such as mucus or other fluids.

Treatment: Endoscopic Endonasal Surgery or open craniotomy, possibly radiation and chemotherapy

Adenoid cystic carcinoma


A rare form of cancer that usually begins in the salivary glands and can spread (metastasize) to the lung, liver and bone.

Treatment: Endoscopic Endonasal Surgery or open craniotomy with radiation therapy, sometimes with chemotherapy

Esthesioneuroblastoma (also called Olfactory neuroblastoma)


A rare type of cancer that forms in the tissues of the upper nasal cavity, near the bone that separates the nasal cavity from the brain. These tissues are involved in the sense of smell. Olfactory neuroblastoma may spread from the nasal cavity to the bone around the eyes, the sinuses, the front part of the brain, or the lymph nodes in the neck. It is the most common type of nasal cavity tumor in children, especially in teens. 

Treatment: Endoscopic Endonasal Surgery; sometimes open craniotomy plus radiation. Chemotherapy is used in advanced cases.

Chordoma


A type of bone cancer that usually starts in the lower spinal column or at the base of the skull. These tumors often develop close to critical anatomical structures, making their complete removal difficult. Local recurrence is common.

Treatment: Endoscopic Endonasal Surgery; sometimes open craniotomy plus radiation (typically proton therapy)

Chondrosarcoma


A type of cancer that forms in the cartilage of bones. As with chordomas, chondrosarcomas of the skull base often develop close to critical anatomical structures, making complete removal difficult. Local recurrence is common.

Treatment: Endoscopic Endonasal Surgery; sometimes open craniotomy plus radiation (typically proton therapy)

Hemangiopericytoma


A rare, aggressive cancer of blood vessels and of the membrane surrounding the brain.

Treatment: Endoscopic Endonasal Surgery or open craniotomy on a case-by-case basis, radiation

Nasopharyngeal cancer


Cancer that forms in tissues that line the tubular passageway behind the nasal cavity (the nasopharynx). These cancers are usually squamous cell carcinomas, which is cancer that begins in flat cells lining the nasopharynx.

Treatment: Radiation and chemotherapy; sometimes Endoscopic Endonasal Surgery or open surgery for recurrence.

Orbital tumors


These tumors are tumors – gliomas – of the optical pathway. There is no standardized, optimal treatment for these cancers and no randomized clinical trials to guide treatment decision-making, so decisions are made based on observational studies, age of the patient and location of the tumor.

Treatment: Endoscopic Endonasal Surgery; sometimes open craniotomy; may also require radiation or chemotherapy depending on pathology.

Sinonasal cancer


These are cancers that develop in the nasal cavity and in the sinuses near the nose. The sinuses are open spaces in the bones around the nose. They are lined with cells that produce mucus that keeps the inside of the nose moist during breathing. These sinuses are found in the lower forehead above the nose, in the cheekbones on either side of the nose and behind the nose in the center of the skull.

Treatment: Radiation and chemotherapy; Endoscopic Endonasal Surgery or open craniotomy

Squamous cell carcinomas


Cancers that begin in squamous cells, which are flat cells that form the surface of the skin, eyes and the lining of hollow organs and ducts of some glands. Most head and neck cancers are squamous cell carcinomas. They can occur in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, and larynx (voice box).

Treatment: Endoscopic Endonasal Surgery or open craniotomy depending on tumor location. Radiation and chemotherapy.

Sarcomas


A type of cancer that begins in bone or in the soft tissues of the body, including cartilage, fat, muscle, blood vessels, fibrous tissue, or other connective or supportive tissue. Different types of sarcoma are based on where the cancer forms. For example, osteosarcoma forms in bone, liposarcoma forms in fat, and rhabdomyosarcoma forms in muscle. Treatment and prognosis depend on the type and grade of the cancer (how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread). Sarcoma occurs in both adults and children.

Treatment: Endoscopic Endonasal Surgery or open craniotomy depending on tumor location, often chemotherapy and radiation

Benign tumors

Cerebrospinal fluid leak (also called CSF leak)


A benign condition caused by leakage of cerebrospinal fluid, the fluid that bathes the brain and spine. The leakage can be due to a tear or hole in the outer membrane that surrounds the brain and spinal cord (the membrane is called the dura mater). The fluid loss can result in a drop in volume and pressure of the fluid bathing the brain and spine. Symptoms of CSF leak can include eye or neck pain, blurred or double vision, impaired hearing, tinnitus, spasms, seizures and other symptoms.

Treatment: Endoscopic Endonasal Surgery, sometimes open craniotomy

Chondroma


An extremely rare, benign tumor that develops in cells that form cartilage. They can occur in the skull base near the orbits and cause compression of structures.

Treatment: Endoscopic Endonasal Surgery

Pituitary gland tumor


A type of benign tumor that develops in the pituitary gland. The pituitary is a pea-sized gland in area of the brain behind the bridge of the nose. It releases hormones that regulate other glands and many functions of the body, including growth. Most pituitary tumors are benign and many cause no symptoms. The symptoms that do occur depend on the hormones that are affected by the tumor or the effect of the mass. Functional pituitary tumors can secret prolactin, ACTH, FSH, LH, TSH, GH. They functional tumor can cause Cushing’s disease, acromegaly. When surgery is indicated due to the effect of the mass, vision problems are the most common symptom.

Treatment: Endoscopic Endonasal Surgery, sometimes open craniotomy. Rarely, it will require radiation.

Craniopharyngioma


A rare, benign brain tumor that usually forms near the pituitary gland and the hypothalamus. They are slow-growing and do not spread to other parts of the brain or to the body. However, as they grow, they may press on nearby parts of the brain such as the pituitary gland, hypothalamus, optic chiasm, optic nerves, and fluid-filled spaces in the brain. This may cause problems with growth, vision, and secretion  of certain hormones. Craniopharyngiomas can occur in children and young adults but also in the elderly.

Treatment: Endoscopic Endonasal Surgery or open craniotomy; they tend to respond well to radiation when needed

Hemangiomas and other vascular malformations


A hemangioma is a benign, excessive collection of blood vessels that can resemble a tumor. Often it is treated with surgery, particularly when located inside the orbit.

Treatment: Endoscopic Endonasal Surgery or transcunjunctival approach. Rarely open craniotomy depending on location.

Inverting papilloma


A tumor of the nasal cavity that develops beneath the nasal lining rather than projecting from it.

Treatment: Endoscopic Endonasal Surgery, sometimes open craniotomy

Juvenile angiofibroma


A benign fibrous tumor that develops in the nasopharynx (the back of the throat) and contains many blood vessels. It usually occurs in adolescent males, and it can be aggressive.

Treatment: Endoscopic Endonasal Surgery, sometimes sublabial approach

Meningioma


A slow-growing tumor that forms in the meninges, the thin membranes that cover the brain and spinal cord. Meningiomas usually occur in adults.

Treatment: Endoscopic Endonasal Surgery or open craniotomy on a case-by-case basis; radiation in some cases

Mucocele


A cyst of mucus secretion on the sinuses.

Treatment: Endoscopic Endonasal Surgery, sometimes open craniotomy

Nasal polyps


Noncancerous growths on the lining of the nasal cavity or sinuses that hang down like grapes. They may cause no symptoms when small, but large nasal polyps can interfere with breathing.

Treatment: Endoscopic Endonasal Surgery

Odontoid diseases


Diseases of the craniocervical junction that can cause compression of the brainstem and or spinal cord. A decompression can be performed via nasal passges (EEA) or transorally. Instability of the head over the cervical area needs to be checked, and the patient may need posterior craniocervical fusion to stabilize it.

Treatment: Endoscopic Endonasal Surgery, often followed by posterior fusion

Trigeminal schwannoma


A rare brain tumor that begins in cells (called Schwann cells) that form protective sheaths around nerve cells. These tumors are almost always benign, but cancerous schwannomas can occur. Trigeminal schwannomas develop in Schwann cells associated with the trigeminal nerve, which is a major nerve that serves the face and muscles of the jaw. Facial pain and numbness are the main symptoms.

Treatment: Endoscopic Endonasal Surgery or open craniotomy, on a case-by-case basis. Rarely requires radiation.

Vestibular schwannoma (also called Acoustic neuroma)


A tumor on the nerve that runs from ear to the brain. It can cause hearing loss and balance problems. Left untreated, it can result in deafness.

Treatment: Open craniotomy only, endoscopic assisted

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Patient Stories Christy Burdette

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When Christy Burdette, a registered nurse, needed surgery for a skull base tumor, she did her homework and, despite the long drive from home, chose the OSUCCC – James.

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