Skull Base Program

The Hartford HealthCare Ayer Neuroscience Institute offers an integrated, tailored approach to caring for tumors and disorders of the skull base, the part of the head behind the eyes and nose.

Our multidisciplinary team includes neurosurgeons, otorhinolaryngologists, endocrinologists, neuro-ophthalmologists, audiologists, oncologists and radiation oncologists. We take pride in creating tailored treatment plans for each patient based on their condition, using the latest technology and most advanced techniques.

The surgical treatment of skull base disorders is complex in that blood vessels, nerves, and other structures pass through this region. Historically, surgery for these disorders required an open technique. Although an open technique may be required in some instances, our neurosurgery and ENT surgical team has extensive experience in the latest minimally invasive techniques.

While some patients require surgical intervention, many of our patients are followed carefully over the years to observe for tumor growth or side effects. Complex cases are discussed at our regularly scheduled multispecialty case conference.


Conditions

The many types of skull base tumors and conditions are classified by type and location in the skull base. Examples of conditions we treat include:

Approximately one in ten adults have an abnormality of the pituitary gland. Most are found incidentally, are benign, and can be monitored over time with no surgical intervention. One reason why a surgeon may offer a surgical procedure could be if the tumor is big enough to press on nearby structures and cause issues with vision or a decrease in normal pituitary function. Another reason for offering a surgical intervention would be if the tumor is causing an over secreting of a pituitary hormone that is in turn causing you harm. Over secretion of pituitary hormone ACTH or adrenocorticotropic hormone causes Cushing’s Disease which can lead to diabetes and heart disease and thereby shorten your lifespan. Over production of pituitary hormone IGF-1 or insulin-like growth factor 1 causes acromegaly in adults or gigantism in childhood. Acromegaly shortens lifespan with complications like high blood pressure, diabetes, and enlargement of soft tissues including the heart (cardiomyopathy).

While there are multiple ways to access the pituitary gland our Skull Base Program physicians specialize in accessing the anterior skull base or “anterior fossa” using the transnasal approach. This means that they use an endoscope or long camera and delicate instruments to go through the nasal passages and sinuses. There is no visible craniotomy scar.

Acoustic Neuromas and vestibular schwannomas are in essence two names for the same tumor. These tumors grow off the sheath or outer covering of the cranial nerves that assist with hearing and balance. Tumors in this region can happen on either the right or left side of the head, are usually benign, and typically cause mild to complete hearing loss and difficulty with balance due to vertigo and dizziness.

While watchful waiting with surveillance imaging may be an option for some tumors, others may require surgical intervention. Access to the lateral skull base or “middle fossa” can be gained through hearing sparing approaches like retrosigmoid or transtemporal craniotomy. Translabrynthine approach craniotomy does not spare hearing. These approaches all require a visible incision.

Enchephaloceles are described as an outpouching of the outer covering of the brain and sometimes brain tissue through a defect in the skull base. These defects can be due to trauma, individual anatomy, or high intracranial pressure. Sometime the defect in the skull base is sharp and may puncture the outer covering of the brain or the “dura” causing a CSF leak. CSF or cerebrospinal fluid is created by your brain and bathes the brain and spinal cord. Your brain creates about ½ quart of CSF daily and reabsorbs it but if there is a hole in the dura it can leak out. People with CSF leaks may notice that they have thin, clear, salty fluid leaking from their noses, their ears, or down the back of their throats. Depending on where the skull base defect is you may be at increased risk for seizures and infections like meningitis.

Treatment for CSF leaks and encephaloceles almost always requires surgical intervention. Access or approach depends on of the defect is in the anterior or lateral skull base. Your skull base specialists will need to patch the hole created in the outer covering of the brain and rid the defected bone of the sharp edges that created the puncture.

Meningiomas are a mostly benign type of tumor the grows from the outer covering of the brain and spinal cord. Small meningiomas may be left alone to watch over time and assess for growth if they are not putting pressure on any other important structures. If a meningioma is putting pressure on an important structure like the optic nerves or blood vessels or if it is growing at a rapid rate your surgeon may encourage surgery to remove it. If a meningioma grows large enough to cause swelling in the brain around the tumor or if it causes seizures your surgeon will strongly encourage surgery.

Meningiomas can occur anywhere on the outer covering of the brain. Therefore surgical treatment of meningiomas can involve numerous techniques to gain access to the tumor including transnasal or anterior, retrosigmoid or lateral, and suboccipital or posterior craniotomies among other non-skull base approaches.

 
  • Chordomas

  • Sinonasal Undifferentiated carcinoma

  • Rathke’s cysts

  • Schwannomas

  • Esthesioneuroblastomas

  • Glomus tumors

  • Craniopharyngiomas


Treatment

While some patients require surgery, many can be monitored carefully for years for tumor growth or side effects.

Surgery can be complex because there are many blood vessels, nerves and other structures in the area. Historically, surgeons used an open technique when operating, and some patients still need this type of approach. But, our surgical team also has extensive experience in the latest minimally invasive techniques that are less risky and patients recover more quickly.


Our Team

Care Coordination

Elizabeth Saunders, RN

Our nurse navigator, Elizabeth Saunders, RN, is here to help patients and their families with all aspects of their journey and plan of care.

You can always contact her with questions or concerns at Elizabeth.Saunders@hhchealth.org, or 959.333.6018.

Skull Base Program Specialists

Nazer Qureshi

4.8

Neurosurgery

Medical Group The Ayer Neuroscience Institute
Southington, CT 06489
More Locations
Plainville, CT 06062
Andrew DeCusati

 

Neurosurgery

Medical Group The Ayer Neuroscience Institute at Hartford Hospital
Hartford, CT 06106
Editha Johnson

4.8

Neuro Ophthalmology

Medical Group Hartford HealthCare Medical Group at Hartford Hospital Department of Neuro-Ophthalmology
Hartford, CT 06106
Daniel Cavalcanti

5

Neurosurgery

Medical Group The Ayer Neuroscience Institute
Bridgeport, CT 06606
Mohamed Akli Zetchi

4.8

Neurosurgery

Medical Group The Ayer Neuroscience Institute
Bridgeport, CT 06606
More Locations
Milford, CT 06461
Vitaly Kantorovich

 

Endocrinology

Medical Group Hartford Hospital Diabetes Life Care Center
Hartford, CT 06106
Aashish Samat

4.8

Endocrinology

Medical Group Hartford HealthCare HealthCenter
Farmington, CT 06032
More Locations
New Britain, CT 06050
Farmington, CT 06032
Belachew Tessema

 

Otolaryngology

The Ear, Nose, & Throat Institute of Connecticut
Farmington, CT 06032
Marc Eisen

 

Neurotology

Ear Specialty Group of Connecticut
Farmington, CT 06032
Fadi Al-Khayer

5

Endocrinology

Medical Group Hartford HealthCare Medical Group
Storrs, CT 06268
More Locations
Manchester, CT 06042
Manmeet Kaur

4.7

Endocrinology

Medical Group Hartford HealthCare HealthCenter
Southington, CT 06489
More Locations
New Britain, CT 06050
Paul Schwartz

4.9

Neurosurgery

Medical Group The Ayer Neuroscience Institute at Hartford Hospital
Hartford, CT 06106
More Locations
Farmington, CT 06032
Samreen Gadit

 

Neurosurgery

Medical Group The Ayer Neuroscience Institute at Hartford Hospital
Hartford, CT 06106
Mark Hornyak

4.7

Neurosurgery

Medical Group The Ayer Neuroscience Institute
Mystic, CT 06355
More Locations
Norwich, CT 06360
Willimantic, CT 06226

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Ayer Neuroscience Institute