Skull base surgery is neurosurgical subspecialty centered on treatment of tumors and vascular lesions situated at the base of the skull (beneath the brain). Dr. Woodall is the only surgeon in the Athens area with skull base and cerebrovascular fellowship training, which means he’s passionate about—and has received additional training and experience to handle—some of the most complex neurosurgical cases.

Your central nervous system consists of your brain, which acts as the “control center,” and the spinal cord, which communicates “messages” to the rest of your body. Delicate structures pass through the base of the skull including the spinal cord, cranial nerves, as well as arteries and veins that support the central nervous system.

Conditions Requiring Skull Base Surgery

Many conditions in the skull base may not require surgery at first, or at all. In some cases, the condition will be observed until the appearance of symptoms that make surgery necessary. Your medical history will be considered, and you will receive a physical and neurological exam—to evaluate your vision, hearing, balance, coordination, reflexes, and ability to think and remember—to determine the severity of your condition.

Conditions that may require skull base surgery include:

Acoustic neuroma — A neuroma is a noncancerous (benign) tumor that appears on a nerve. Neuromas can be found wherever you have nerves, but an acoustic neuroma, also known as a vestibular schwannoma, usually appears on the vestibular nerve. This nerve connects the brain to the inner ear and is closely associated with the nerve that enables you to hear.

The treatment of your acoustic neuroma will be determined by the size of the tumor and your symptoms. If the tumor is small and does not cause any symptoms, it will likely be monitored with MRI scans over time. However, if the acoustic neuroma grows quickly, is large, or causes problems such as hearing loss, a ringing in the ear, or imbalance, then treatment (surgical removal or focused radiation) may be necessary.

Cholesteatoma — A cholesteatoma is a benign cystic lesion that can develop in the middle of the ear, behind the eardrum. A cholesteatoma, caused by a birth defect or multiple ear infections, can eat into the bone and cause permanent hearing loss if untreated.

Encephalocele — Defects at the base of the skull can sometimes allow normal brain tissue to sag into places that the brain does not belong.  Sometimes, this can lead to spinal fluid leakage into the nose and throat, or other brain dysfunction (such as seizure disorders). In select cases, surgical repair is necessary to treat these relatively rare disorders of the skull base and meninges.

Meningioma — A meningioma is a tumor appearing on the meninges, which are the membranes surrounding the brain and spinal cord. Although a meningioma is the most common kind of primary tumor that forms in the head, they are almost always noncancerous. Meningiomas situated at the base of the skull are sometimes removed employing skull-base approaches (which emphasize the removal of bone in order to avoid retraction of delicate brain tissue).

As is the case with acoustic neuromas, meningiomas may require only observation, particularly because they sometimes grow slowly. But depending on size or location, surgery may be required due to symptoms including:

  • Double vision or vision loss   
  • Hearing loss or ringing in the ears
  • Loss of smell
  • Seizures or coordination problems
  • Headaches
  • Arm or leg weakness

Dr. Woodall is the only surgeon in the area with fellowship training in skull base approaches for tumors including meningioma and acoustic neuroma.

Vascular compression syndromes — As the name suggests, vascular compression syndromes occur when there is pressure on the cranial nerves, causing pain or muscle spasms. 

Skull base defects — The base of the skull can become damaged due to pressure caused by benign or cancerous tumors, or from an injury. Some skull base defects can lead to a leak of cerebral spinal fluid (CSF), a clear fluid that surrounds the brain and spinal cord, which can cause other conditions (such as headaches, bleeding, or meningitis). 

Contact M. Neil Woodall, MD, Today

If you have been diagnosed with a brain tumor, acoustic neuroma, meningioma, encephalocele, or CSF leak, or have any questions regarding potential treatment, Dr. Woodall has the skill, care, and experience to ensure you receive the treatment you need—without leaving the Athens area. Contact our office today.