Skull base surgery is one of the most technically demanding subspecialties in neurosurgery, requiring precision and expertise to address pathologies in an anatomically complex region where critical neural and vascular structures converge.
The Nebraska Medicine Skull Base Program offers advanced surgical interventions for patients with tumors and diseases affecting this crucial area, combining innovative techniques with multidisciplinary expertise.
“The skull base is a critical area that separates the intracranial structures from the sinuses and ear,” says Christie Barnes, MD, otolaryngologist and head and neck surgeon.
Dr. Barnes explains that performing surgery in this region is challenging due to the presence of critical nerves and blood vessels.
“Skull base surgeons are uniquely trained in fellowship to understand the anatomy of this area in both a dorsal and ventral way so that diseases in this location are treated safely and effectively,” she says. “We work closely with endocrinologists and specially trained medical and radiation oncologist to customize patient treatments with both a multidisciplinary clinic and multidisciplinary tumor board.”
Comprehensive and specialized care
The Skull Base Program stands as the region's only comprehensive center dedicated to treating conditions affecting the skull base. The program offers:
- Fellowship-trained neurosurgeons and otolaryngologists with advanced expertise in cranial base approaches and reconstruction.
- Minimally invasive endoscopic techniques that reduce morbidity while maximizing therapeutic efficacy.
- Preservation of critical neurological function through intraoperative monitoring and meticulous surgical planning.
- Multidisciplinary collaboration that integrates neurosurgery, otolaryngology (ENT), endocrinology, head and neck surgical oncology, medical oncology and radiation oncology.
This team-based approach ensures comprehensive evaluation and personalized treatment plan for each patient.
Conditions treated
The Skull Base Program provides specialized care for a range of conditions, including:
- Pituitary adenomas and other sellar/parasellar tumors.
- Meningiomas of the cranial base.
- Vestibular schwannomas (acoustic neuromas).
- Chordomas and chondrosarcomas.
- Craniopharyngiomas.
- Cerebrospinal fluid (CSF) leaks.
- Adenocarcinoma involving the skull base.
- Squamous cell carcinoma with skull base invasion.
- Tumors of the optic nerve and medial orbit.
- Traumatic skull base fractures and defects.
“Skull base surgery is a newer surgical specialty combining the expertise of neurosurgeons and ENT surgeons to addresses diseases of the skull base, such as tumors and CSF leaks, with a less invasive approach than traditional cranial surgery,” Dr. Barnes says. “It combines microscopic and endoscopic techniques to improve visualization and decrease morbidity on the brain from retraction.”
Patient experience and treatment approach
Patients referred to the Skull Base Program can expect a structured evaluation process:
- Pre-appointment preparation: Patients may undergo specialized imaging studies before their initial consultation to facilitate comprehensive assessment.
- Multidisciplinary evaluation: Experts review imaging studies and medical history to develop a complete diagnosis.
- Treatment planning: The team determines the best therapeutic approach, which may include:
- Endoscopic endonasal surgery.
- Traditional open craniotomy approaches.
- Combined approaches for complex lesions.
- Stereotactic radiosurgery.
- Conventional radiation therapy.
- Medical management for appropriate conditions.
- Comprehensive education: Patients receive detailed information about their diagnosis and treatment options, with ample time for questions and concerns.
“The Nebraska Medicine skull base team takes a very patient-centered, less invasive approach to treating these hard-to-reach conditions with the goal of reducing patient recovery, improving functional outcomes and improving patient satisfaction,” Dr. Barnes says.
Advanced surgical techniques
The program emphasizes minimally invasive approaches whenever clinically appropriate. These techniques may allow for:
- Reduced hospitalization duration.
- Decreased postoperative pain.
- Faster recovery times.
- Minimal visible scarring.
- Lower rates of surgical complications.
- Enhanced preservation of neurological function.
For lesions requiring traditional approaches, the team employs advanced neuroimaging, neuronavigation and neurophysiological monitoring to maximize safety and efficacy.
Why choose Nebraska Medicine?
The Nebraska Medicine Skull Base Program distinguishes itself through:
- Team-based, personalized care coordinated across multiple specialties.
- Advanced technological capabilities not available elsewhere in the region.
- Comprehensive management from diagnosis through recovery and rehabilitation.
- Access to clinical trials and innovative therapeutic approaches when appropriate.
- Outcomes that meet or exceed national benchmarks for complex skull base procedures.
For physicians managing patients with suspected or confirmed skull base pathology, early referral to a specialized center can significantly impact treatment outcomes. The Skull Base Program accepts referrals for both initial evaluation and second opinions.
For referrals or additional information, please call 402.559.5208.