Tumors of The Base of The Skull and Acoustic Neuromas
Tumors involving the base of the skull constitute a very special category of brain tumors. Many of them are benign. They are very difficult to treat and the surgery required to treat them is technically demanding. Surgical treatment is often dangerous. Many of these tumors cause very few symptoms when observed over long periods of time. X-ray therapy of several different kinds is now available as an alternative to surgery. I have been involved in the management of these tumors for more than 40 years and was actively involved in establishing one of the first centers in the world for their diagnosis and treatment.
My own personal surgical series contains over 2000 patients. I am no longer actively involved in this complex surgery, but I retain an interest in patients with these tumors. Based upon my long experience with them and the many articles and books which I have prepared concerning their diagnosis and treatment, I am happy to help patients make decisions about treatment. In order to do so, I need to review the imaging studies and discuss symptoms. Physical examination is usually not very important. The key issues are typically the history and the appearance and behavior of the tumor. With many of these tumors there is the option of simply observing the tumor and acting only when the tumor grows or when symptoms become serious. Some of the tumors can be treated with radiation. The radiation therapy is usually focused and can be one of three kinds: Gamma knife, Cyberknife, and linear accelerator radiation. Surgery is often an alternative to radiation. Sometimes surgery is required because of the severity of symptoms or rapid growth of the tumor. I now maintain a program which is designed to allow me to review individual patients with their imaging studies, and then, to discuss the alternatives of management helping them come to a decision about what is the most appropriate management for their tumor.
Even though many of these tumors are benign, their therapy is not. Potential complications are extremely important, and because the majority of these tumors can be cured, the presence or absence of complications is doubly important. I am happy to try to help with this all important decision without having any biases towards one course of treatment or another just because one particular treatment is what I do. Many patients have found this third party approach helpful to them in their decision making. Once a decision is made, I can refer the patient to the best physicians and centers for them, considering their tumor and geographic locations.