Skull base tumours grow along the floor of the skull, where the brain sits close to the nerves of vision, hearing, facial movement and swallowing, and to the major arteries. Many are benign, and treatment ranges from monitoring with MRI to surgery through the nose with an endoscope or open skull base surgery, sometimes combined with radiotherapy. For patients in Lahore, the right plan depends on the tumour type, its exact position and the symptoms it causes.
Because these tumours are in a crowded and delicate area, skull base surgery is usually planned as a team effort, focusing on removing the tumour safely while protecting nerve function.
The skull base is the bony floor on which the brain rests. It has openings through which the cranial nerves, the carotid and vertebral arteries and the spinal cord pass. It is divided into front, middle and back regions, each with different structures at risk, which is why symptoms and surgical approaches vary so much between patients.
Symptoms depend on which structures are being pressed:
Seek emergency care for sudden severe headache with loss of vision or double vision (which may mean pituitary apoplexy), clear fluid dripping from the nose with fever or neck stiffness, or rapidly reducing consciousness.
An MRI with contrast is the key scan, and a CT scan shows the bone of the skull base. Depending on the tumour, tests may include hormone blood tests, visual field testing, hearing tests (audiogram), and an angiogram to assess blood vessels. Most decisions are reviewed by a team that may include the neurosurgeon, ENT surgeon, endocrinologist, ophthalmologist, oncologist and radiologist.
Some small benign tumours, such as a small acoustic neuroma or an incidental meningioma, can be watched with repeat MRI, especially in older patients. Surgery is not always needed.
Tumours in the middle of the skull base, such as pituitary adenomas, many craniopharyngiomas, tuberculum sellae meningiomas and clival chordomas, can often be removed through the nose using an endoscope, with no cut on the face or scalp. This avoids lifting the brain to reach the tumour. The pituitary operation is described in detail on our endoscopic pituitary surgery page, and the wider technique on the endoscopic brain surgery page. Extended endoscopic approaches create a larger opening in the skull base, so careful reconstruction, often with a flap of nasal lining, is essential to prevent a CSF leak.
Tumours that extend out to the side, lie behind the ear, or wrap around arteries and nerves are often better reached by an open approach, such as a pterional, subfrontal, orbitozygomatic or retrosigmoid craniotomy. The microscope and navigation help the surgeon work along natural corridors with minimal pressure on the brain. Sometimes endoscopic and open routes are combined or staged.
Radiosurgery is a useful option for small acoustic neuromas and meningiomas, and for residual tumour left on nerves or vessels. Chordomas usually need high-dose radiotherapy after surgery. The aim is long-term control while preserving function.
Skull base care usually involves several specialists. ENT surgeons may help with the nasal approach or ear-based routes. Endocrinologists manage hormone balance before and after pituitary and craniopharyngioma surgery. Ophthalmologists track vision, and oncologists plan radiotherapy for tumours like chordoma. At consultation, Dr. Khawar Anwar discusses which of these specialists may be involved, so that each patient's priorities, such as preserving vision, hearing or facial movement, are central to the decision.
Hospital stay commonly ranges from a few days after endoscopic surgery to a week or more after a larger open operation. Nasal crusting and congestion are expected for some weeks after endoscopic surgery. Recovery of nerve function, if affected, can take months. Follow-up MRI, hormone tests and eye or hearing checks continue over the long term.
Risks depend on the tumour and approach and include CSF leak, meningitis, hormone problems and diabetes insipidus, injury to cranial nerves (vision, eye movement, facial movement, hearing or swallowing), stroke or arterial injury, bleeding, and tumour regrowth. Your specific risks are explained before any treatment. Related tumour types are covered on the brain tumour surgery page.
Most, such as pituitary adenomas, meningiomas, schwannomas and craniopharyngiomas, are benign. Chordomas and chondrosarcomas are malignant bone tumours but grow locally and usually do not spread widely.
No. The endoscopic nasal route suits tumours in the middle of the skull base. Tumours extending to the side or behind the ear usually need an open approach, and some need both.
Hearing preservation depends on tumour size and the hearing you have before treatment. Small tumours may be watched or treated with radiosurgery; options are discussed with your hearing results in mind.
Skull base tumours affect hormones, vision, hearing and other nerves, so input from ENT, endocrinology, ophthalmology and oncology gives safer and more complete care.
Bring your MRI and CT scans and any eye, hearing or hormone reports, and book an appointment online or by phone.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.