Minimally invasive surgery for skull base tumors at Mayo Clinic in Florida

Skull base tumors include meningiomas, pituitary tumors, clival chordomas, nasal tumors, chondrosarcomas, and craniopharyngiomas.

Many skull base tumors involve the nose and nasal passages and compress the brain. A few years ago, most surgical resections for such tumors at Mayo Clinic involved a frontal craniotomy and lateral rhinotomy. Endoscopic approaches were available but were not often prescribed.

Sagittal MRI scan of pituitary tumor

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Since then, a convergence of new technologies has made minimally invasive approaches safe and viable treatment alternatives for some tumors that can be approached through the nose and nasal passages, including large pituitary tumors. These technological advances have prompted an increase in minimally invasive techniques for skull base tumors across Mayo's three campuses.

At Mayo Clinic in Jacksonville, Florida, William E. Bolger, M.D., an otorhinolaryngologist with special training in the endoscopic, minimally invasive approach to the nose and sinuses, has joined the interdisciplinary team caring for patients with skull base tumors. As Dr. Bolger notes, "The advantage of these new approaches is that we get good exposure to the tumor without an external incision and facial trauma. Many tumors, such as meningiomas, that once required an open approach can sometimes be managed through an intranasal endoscopic approach."

His neurosurgical colleague Robert E. Wharen, M.D., adds that endoscopic techniques can reduce patient morbidity when used in appropriate situations. When warranted, minimally invasive approaches can often produce less discomfort and shorten hospital stays.

Several innovations available at Mayo Clinic have advanced minimally invasive skull base surgery:

• Image-guided surgery aids in tumor localization.
• Angled-view endoscopes can move with ease and flexibility through nasal passages while providing a wide-angle view of the tumor.
• Intraoperative MRI allows the surgeon to check for residual traces of the tumor during the procedure.

Dr. Bolger explains, "We use minimally invasive techniques most often to treat pituitary tumors, but we also use them to manage some benign bone tumors, encephaloceles, and other tumors, such as meningiomas."

These new technologies combined with specialized surgical techniques have enhanced individualized patient care. They provide another option for many patients with skull base tumors. But, as Drs. Bolger and Wharen point out, each care plan at Mayo is based on patient needs—the patient's unique anatomy and the nature of the tumor. Dr. Bolger adds that a "nonbiased approach based on these critical factors continues to be our guiding principle in managing skull base tumors."