Treatment of Sinus and Skull Base Tumors
Froedtert & the Medical College of Wisconsin offer the highest treatment volumes and most advanced care for sinus and skull base cancers than any other facility in the state. As such, we treat some of the most complex and rare cases in the country. We treat all sinus and skull base cancers with a multidisciplinary approach aimed at providing the latest treatments and best possible care.
Sinus and skull base cancers are never typical and each case requires custom treatments to meet each patient’s individual needs. Our collaborative team of highly trained specialists has unparalleled depth, expertise and experience in treating challenging cases of sinus and skull base cancer.
Lateral Skull Base Cancers
Lateral skull base cancers include squamous cell and basal cell carcinomas as well as adenoid cystic carcinomas and other rare cancers.
Minimally invasive technology is often used during surgery to remove lateral skull base tumors. Surgeons can use endoscopes to help clear the disease from surrounding areas and see things that can’t be seen with a microscope because of the angle of approach. Endoscopes are helpful with some tumors, such as chondrosarcoma and chordomas, where the goal may be to debulk the tumor (make it smaller) so it can then be treated with radiation.
With lateral skull base tumors, cranial nerves can be easily affected, either because of the disease itself or because of the treatment required to remove the tumor. Depending on their unique circumstance, patients may have difficulty with swallowing, voice, speech, facial sensation, facial movement and even hearing loss. That means rehabilitation is necessary for many patients.
Our rehabilitation team includes experts in speech language pathology, audiology and other subspecialties that patients require as part of their rehabilitation. Team members are dedicated to speech, voice, swallowing, hearing loss and facial nerve recovery, among other things. In fact, Froedtert & the Medical College of Wisconsin have one of only two facilities in the state with a facial nerve retraining program.
Anterior Skull Base Cancers
Anterior skull base tumors occur primarily in the nose and sinuses. The most common type of benign tumor is called an inverted papilloma. The most common malignant tumors include squamous cell carcinomas, adenocarcinomas, esthesioneuroblastoma and lymphomas.
Minimally invasive surgery, using an endoscope and working through the nose, along with imaging-guided technology, can be used to remove anterior skull base tumors. Our goal is to start with the least invasive, but still effective treatment approach. External incisions are sometimes necessary, but minimally invasive techniques are much preferred because they mean less recovery time and better cosmetic results. The surgical approach used depends on the type, location and extent of the tumor.
We also draw on the expertise of neurosurgeons, oculoplastic surgeons, plastic surgeons and other specialists as needed to give the best possible access to the tumor. By working in conjunction with a variety of medical specialists, we can offer more effective treatment options. We do more endonasal (through the nose) procedures than anyone else in the region, and that means better patient care and speedier recoveries.
While sinus and skull base tumors are often benign, even benign tumors require advanced treatment because of complex anatomy. Our nationally recognized physician specialists work together, drawing on each other’s expertise to develop the best treatment approach for each patient. Team members include neurologists, head and neck surgeons, interventional neuroradiologists, neurosurgeons and others who each have extensive experience and specialized training in their fields. In fact, we have the largest number of fellowship-trained otolaryngology specialists in the state.
The nature of sinus and skull base cancers means that some patients may come to us with advanced disease. Our patient-centered care philosophy means that we help each patient through the treatment process with support, compassion, understanding and caring, as we provide leading-edge medical care.
Treatment for sinus and skull base cancers depends on the type, and extent and location of the tumor, among other factors. Patients may require surgery, chemotherapy and radiation or a combination of treatments. For many patients, treatment may require highly specialized radiation treatments such IMRT (Intensity-Modulated Radiation Therapy), TomoTherapy® or Gamma Knife. Froedtert & the Medical College of Wisconsin have one of the few programs to offer all of these options.
Our expertise begins with the imaging technology used to determine the extent of the disease and whether it can be treated surgically. Once a treatment approach is determined and treatment begins, reconstruction and rehabilitation are important factors in the treatment plan.
Reconstruction After Surgery
Reconstruction after surgery to remove sinus and skull base tumors varies with the area that has been affected, but the techniques are similar to those used in other head and neck surgeries. Reconstruction is tailored to the individual patient and is often successfully accomplished utilizing local tissue as well as adjunctive synthetic materials. If the defect is not amenable to such techniques, tissue from another area of the body is removed by one surgeon while another surgeon removes the tumor or diseased area.
The reconstruction process begins immediately during the same procedure to minimize the impact on the patient. The goal of reconstruction is to repair the defect caused by removing the tumor — whether it was malignant or benign — while preserving function as much as possible.