Cranial-base, or skull-base, tumors are traditionally among the most challenging to treat, but the Center for Cranial-Base Surgery at Penn offers new hope for patients with these complex tumors.
The skull base forms the floor of the cranial cavity and separates the brain from the facial structures. Anatomically, the region is difficult to access and poses many surgical challenges. It includes the nose and nasal passages, the pituitary gland and the frontal lobe of the brain and the brain stem.
Physicians at Penn’s Center for Cranial-Base Surgery take a targeted, comprehensive, multidisciplinary approach that focuses on minimally invasive techniques, including endoscopic surgery and radiation. It is a collaborative effort that brings together the best talents and skills from each field.
“Penn’s Center is truly integrated and interactive,” said Bert W. O’Malley, Jr, MD, chair of the department of otorhinolaryngology. “We bring together specialists in neurosurgery, otorhinolaryngology, radiation oncology, neuroradiology and oncology who meet to discuss each case. The group determines the best treatment plan based on the unique situation of each patient.”
The diagnosis of a skull-base tumor can be devastating for a patient. The need to deal with multiple specialists from many different fields can make the diagnosis overwhelming. The Center for Cranial-Base Surgery at Penn brings all of those specialists together along with a patient coordinator to guide the patient through the program. When combined with the minimally invasive treatments available at Penn, the process becomes easier, less stressful and more efficient for patients.
Penn surgeons are pioneers in minimally invasive approaches to treating tumors. Currently, state-of-the-art endoscopic endonasal resection of skull-base tumors resulting in minimal trauma to the brain is performed at Penn.
In addition, trans-oral robotic surgery (TORS)—using a robotic-assisted technique to operate on tumors of the mouth, throat and neck—was invented at Penn. Surgeons from otorhinolaryngology and neurosurgery are now collaborating on bringing those techniques to cranial-base procedures.
“We looked at the techniques developed in TORS and began to discuss ways we could use the same technology in cranial-base surgery,” said M. Sean Grady, MD, chair of the department of neurosurgery. “We are still in the study stage, but we are using what was learned in developing TORS to create the next step in minimally invasive brain surgery.”
Penn neurosurgeon John Y. K. Lee, MD, explains that cranial-base surgery poses a new challenge for the surgical robot. “Most robotic-assisted surgery is performed through soft tissue, but the brain is heavily protected by bone. This is good for us as humans, but presents special challenges to a surgeon,” said Dr. Lee. “We are working closely with Intuitive Surgical (manufacturer of the daVinci® surgical robot) to develop new tools that can be used to access the skull base.”
Dr. Lee said he is hopeful that the tools needed to perform robotic-assisted skull-base surgery will be ready for clinical trials soon.
True to Penn’s mission, the Center for Cranial-Base Surgery also has a strong research and education component. The state-of-the-art skull-base training lab was established for training residents and fellows in surgical procedures as well as how to work as part of a team.
“Along with surgery, we teach students how to build relationships. We want these new physicians to learn how to work, think and create together as a team,” said Dr. O’Malley. “There really is no other center like this in the world.”
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