Lateral Skull-Base Surgery

Explained in simple words

1Lateral skull-base surgery is a highly specialised operation done at the base of the skull, behind and below the ear.

2The skull base is the floor of the head, where the brain sits above and the ear, nerves and big blood vessels pass through.

3It is one of the most difficult areas in the body to operate on, because so many important structures are packed close together.

4The nerve that moves the face, the nerve for hearing and balance, and the main blood vessels to the brain all pass through this small area.

5A tumour or a disease growing here can press on these structures and cause serious problems.

6The commonest tumour in this region is called acoustic neuroma, a slow-growing swelling on the balance and hearing nerve.

7It usually causes hearing loss in one ear, ringing in that ear, and unsteadiness that develops slowly over months or years.

8Another type is a glomus tumour, which arises from tiny blood-vessel tissue and can cause a pulsing sound in the ear, like a heartbeat.

9Long-standing ear infection with a cholesteatoma, which is a skin cyst that eats bone, can also spread into this area and become dangerous.

10These tumours are mostly not cancer, but they still need treatment because they keep growing and press on the brain and nerves.

11Warning signs are hearing loss in only one ear, ringing in only one ear, facial weakness, or unsteadiness that keeps increasing.

12If you notice these, do not ignore them. Early treatment gives a much better result and a much safer operation.

13Diagnosis is made with a hearing test, balance tests and an MRI scan, which shows the exact size and position of the tumour.

14Surgery in this area is done through the bone behind the ear, using a high-powered microscope and very fine instruments.

15During the operation the facial nerve is monitored electrically at every step, so that the surgeon knows immediately if it is at risk.

16The main goals are to remove the disease completely, to protect the facial nerve so the face is not paralysed, and to protect the brain.

17Where possible, hearing is also preserved, though this depends on the size and position of the tumour.

18This surgery requires special training. Dr. Rohiwal completed a fellowship in lateral skull-base surgery with Prof. Mario Sanna in Piacenza, Italy, and temporal-bone training with Prof. Ugo Fisch in Switzerland.

19The operation is done under general anaesthesia and can take several hours, depending on the size of the tumour.

20Patients usually stay in hospital for several days and are watched closely afterwards.

21Some unsteadiness is common for a few weeks after surgery, because the balance organ on that side is affected. The brain gradually adjusts.

22Balance exercises are started early and speed up this recovery a great deal.

23Not every tumour needs surgery. For small tumours in elderly patients, careful observation with repeat scans, or radiation treatment, may be advised instead.

24The doctor will explain all the options, the risks and the expected outcome clearly before any decision is taken.