COMPLEX SKULL BASE TUMORS

The brain is the most complex organ of our body. Most types of brain surgery are critical and complicated processes that require expert surgical care. Each surgery is treated on a case-by-case basis because the outcome may vary in each case. Although surgeons are extremely careful and thorough while operating, brain surgery is associated with several risks. It can also take time to recover after brain surgery, especially if open surgery is being performed. Brain surgery is not always dangerous. All surgical procedures carry some amount of risk, whereas brain surgery carries a higher risk because it is a major medical event.

Skull base tumors, which are situated at the base of the brain need considerable expertise. Certain brain tumours can be very difficult to treat due to:

  1. LOCATION- Functional areas, Deep-seated, neuro-vascular proximity

  2. SIZE- Larger the tumor, difficult is the surgery as the brain matter gets adherent to the tumor. Even a small tumour can be very complex due to its deep location

  3. BLOOD SUPPLY- Some tumors like meningiomas can be extremely vascular, causing a lot of blood loss during surgery

  4. VENOUS INVOLVEMENT- Some tumors like meningiomas grow inside the venous channel posing a greater challenge

WHAT MAKES THEM COMPLEX?

Deep central location

 Relation of important structures around
 Relation of important structures around

Location of 3rd ventricle

CT-After surgery showing total excision

1.LOCATION: Deep Central Location. Colloid Cyst in 3rd Ventricle
CT-After surgery
CT-After surgery
2.LOCATION, SIZE, AGE: Giant craniopharyngioma in a 4 year old baby

3D Scan- Before surgery

CT Scan-After Surgery showing partial excision

(Operated through a single approach)
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3.COMPLEX ANATOMY AROUND THE TUMOR & THE VASCULARITY : GIANT PETRO-CLIVAL MENINGIOMA

Giant petro-clival meningioma

Giant petro-clival meningioma are one of the most difficult meningiomas of the brain due to their deep location, high vascularity, proximity to the brain stem, and important blood vessels and nerves.
Tumor in the third ventricle- MRI BEFORE SURGERY
Tumor in the third ventricle- MRI BEFORE SURGERY
4. DEEP LOCATION AND VASCULARITY THIRD VENTRICULAR MENINGIOMA

Tumor in the third ventricle- MRI AFTER SURGERY showing total excision

Tumor in the third ventricle- MRI BEFORE SURGERY

Third ventricular meningiomas can be difficult to remove due to very narrow access, location and vascularity
MRI AFTER SURGERY
MRI AFTER SURGERY
5.VENOUS DISPLACEMENT

Venous displacement

ARTERIAL DISPLACEMENT
ARTERIAL DISPLACEMENT

Venous displacement

Tumor removed en-mass

These tumors grow by displacing important vessels of the brain. Injury to any one of them can cause disastrous results.
VENOUS INVOLVEMENT
VENOUS INVOLVEMENT
6.VENOUS INVOLVEMENT

Venous Involvement

Post-op venous infarct

MRI- Three months later showing resolution of infarct

Tumor over the motor strip showing involvement of the veins

VENOUS INVOLVEMENT
VENOUS INVOLVEMENT
VENOUS INVOLVEMENT
VENOUS INVOLVEMENT
7.NEURAL RELATIONSHIP

Growth in cervices (between brain, arteries and nerves) EPIDERMOID TUMORS

After completion of tumor removal

Facial nerve

Epidermoid tumors are known to in-grow in the cervices of the nerves, blood vessels and the brain.
VEINOUS INVOLVEMENT
VEINOUS INVOLVEMENT
8.ARTERIAL DISPLACEMENT

Arterial displacement

MRI before surgery

Post-surgery CT Scan

Arterial displacement
Arterial displacement
These tumors are extremely vascular. The goal of the surgery is to remove the tumor completely if possible with preservation of the neural tissue
ARTERIAL DISPLACEMENT
ARTERIAL DISPLACEMENT
9.CROWDED SPACE- Cerebello-pontine angle Meningioma
CROWDED SPACE- Cerebello-pontine angle Meningioma
CROWDED SPACE- Cerebello-pontine angle Meningioma
CROWDED SPACE- Cerebello-pontine angle Meningioma
CROWDED SPACE- Cerebello-pontine angle Meningioma

Cerebello-pontine angle Meningioma

Trochlear Nerve