Benign Skull Base Tumors

Benign tumors found in the skull base region can cause significant problems. They also can be difficult to diagnose and treat.

UC Irvine skull base surgery specialists are skilled at determining the type of tumor, its precise location and the best treatment method to preserve your function.

Benign skull base growths include:

Acoustic neuromas are benign, slow-growing tumors of the vestibulocochlear nerve, which connects the ear to the brain. Also called vestibular schwannomas, these tumors can grow and damage the adjacent brain stem and important nerves as they expand. Symptoms include unsteady balance or dizziness, hearing loss in the affected ear and ringing (tinnitus) in the affected ear.

Treatment includes watchful waiting, surgery or stereotactic radiotherapy. Surgery is performed with a team comprised of a neuro-otologist and a neurosurgeon. Together, they decide how best to approach and remove the tumor while preserving hearing and facial nerve function. Specialized monitoring of the facial nerve and hearing are required during surgery.

Another treatment option involves stereotactic radiosurgery, a type of radiation therapy that can focus high-powered X-rays on the tumor.

Pituitary tumors consist of benign adenomas, invasive pituitary adenomas and pituitary carcinomas, which are cancerous. Noncancerous adenomas rarely spread beyond the pituitary gland and surrounding tissues. Invasive pituitary adenomas are not cancerous, but they can spread to the bones of the skull or into the sinus cavity below the pituitary gland.

Treatment options include surgical removal of the tumor by a neurosurgeon or otolaryngologist, followed by medications to control the growth of the tumor and manage hormone levels.

Meningiomas grow from the meninges, the membranes that surround the brain and spinal column. These tumors are usually noncancerous (benign). Symptoms vary depending on where the tumor is located and how large it becomes. It can affect vision and hearing, as well as cause memory problems and weakness in the limbs.

Treatment for a meningioma includes monitoring the tumor's growth, surgery for removal or stereotactic radiosurgery. If the tumor is causing symptoms, such as dizziness or hearing loss, or it is getting larger, a neurosurgeon, a neuro-otologist or a head and neck surgeon will remove the tumor.

Some patients also need radiosurgery as a primary or adjunct treatment.

Pineal tumors grow near the pineal gland, a small structure found deep within the brain. The pineal gland plays a key role in the body's endocrine functions, such as releasing the hormone melatonin, which is important in regulating circadian rhythm. There are many types of pineal tumors and most are noncancerous. The most common types are: gliomas, germ cell tumors and pineal cell tumors.

Treatment typically begins with a surgical biopsy to determine the exact type of tumor. Surgery is required to remove the tumor. Cancerous germ cell tumors also are treated with chemotherapy and radiation.

Craniopharyngiomas  are noncancerous tumors that develop near the pituitary gland. This type of tumor can put pressure on the brain and impair the normal function of the pituitary gland, resulting in hormone imbalances and stunted growth in children. Increased pressure can damage nerves around the eyes and cause headaches, nausea, vomiting (particularly in the morning) and difficulty with balance. It also can damage the optic nerve.

Surgery has been the main treatment for craniopharyngioma. Another option is radiation treatment or radiation along with a smaller surgery.

Paragangliomas are rare tumors that form near the carotid artery, along nerve pathways in the head and neck and in other parts of the body. Some paragangliomas make extra catecholamines — hormones produced by the adrenal glands — called adrenaline and noradrenaline. The release of these extra catecholamines into the blood may cause symptoms such as high blood pressure, headaches, sweating, fast or irregular heartbeat, paleness and shakiness.

Treatment usually consists of surgery by a neurosurgeon and/or an otolaryngologist to completely remove the tumor. If the tumor is in the adrenal gland, the entire adrenal gland is removed.

Another type of paraganglioma is a carotid body tumor (CBT), which is rare and slow-growing. There are three types:

• Familial
• Sporadic
• Hyperplastic

Symptoms of CBT usually include a mass in the neck that can be felt. Carotid body tumors can be treated with either surgery or radiotherapy.

Hemangiomas are an abnormal accumulation of blood vessels in the skin or internal organs. Hemangiomas appear as a red or reddish-purple, raised sore. Most hemangiomas are on the face and neck. Superficial or "strawberry" hemangiomas may not need treatment and often go away on their own. In some cases, a laser may be used to remove the small vessels to decrease the appearance of the lesion.

Treatment of cavernous hemangiomas affecting the eyelid and blocking vision usually involves lasers or steroid injections to shrink the mass. In children, this allows vision to develop normally. Mixed hemangiomas may be treated with steroids either as oral medicines or injections. Beta-blocker medicines, such as propranolol, also may help reduce the size of a hemangioma.

Glomus vagale tumors are growths that originate in the glomus bodies near the vagus nerve, the longest of the cranial (or skull) nerves. Symptoms include vocal cord paralysis, pulsatile tinnitus and difficulty swallowing.

Typically, surgery by an otolaryngologist is recommended to remove the tumor. If the tumor extends into the brain, a neurosurgeon assists in tumor resection.

Glomus jugulare tumors are rare, slow-growing tumors that start in the temporal bone (ear bone) and spread throughout the ear. The most common symptoms are a pulsing, whooshing sound in the ear and hearing loss. The tumor eventually can spread to involve the brain, the facial nerve and the inner ear, affecting hearing and balance. They also are a type of paraganglioma.

These tumors are treated surgically or with stereotactic radiosurgery.  

Angiofibromas are noncancerous tumors of the nasal cavity that almost exclusively affect adolescent boys. It also may be called juvenile nasopharyngeal angiofibroma (JNA).

Surgery is usually performed to remove angiofibromas. This type of tumor can sometimes be removed through an endoscope inserted through the nose.

For angiofibroma tumors that extend into the cranial cavity and can't be removed surgically, radiation therapy is recommended. Medications are sometimes used to reduce the tumor's size.

Trigeminal schwannomas are uncommon, noncancerous tumors of the nerve that supplies sensation to the face. These tumors tend to grow slowly and cause numbness of the facial area.

Surgery is the most common treatment, although some can be treated with stereotactic radiosurgery or observation.

Vagal schwannomas are tumors of the vagal nerve, which controls the vocal cord, among other functions.

These tumors are most commonly treated with surgery, although some older patients with good vocal cord function may be observed. In certain patients, some of these tumors can be treated with stereotactic radiosurgery.

Jugular foramen schwannomas are rare intracranial tumors involving the jugular foramen, which is a large opening at the base of the skull that contains the lower cranial nerves and major vascular structures. This type of tumor is generally slow-growing.

Surgery is often the treatment of choice.

For more information or to schedule a consultation, call 714-456-6966 for our neurosurgeons or 714-456-7017 for our head and neck surgeons.