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Skull Base Lesions

Dr. Ted McRackan

Skull base lesions vary in size, location, and severity, so every case is unique. At MUSC Health ENT, we take a team approach to each case – this means your primary physician may work with our ear nose and throat subspecialists (neurotologists, rhinologists, or head and neck oncologists), neurosurgeons, and radiation oncologist to determine the diagnosis and best treatment for you.

Acoustic Neuroma

Acoustic neuroma (vestibular schwannoma) is a non-cancerous tumor that may develop from an overproduction of Schwann cells that press on hearing and balance nerves in the inner ear. Schwann cells are cells that normally wrap around and support nerve fibers. If the tumor becomes large, it can press on the facial nerve or brain structure. Unilateral acoustic neuromas affect only one ear and occur most often between the ages of 30 and 60. Bilateral acoustic neuromas affect both ears and are hereditary, caused by a genetic disorder called neurofibromatosis-2.

Symptoms may include hearing loss, feeling of fullness in the ear, tinnitus (ringing), dizziness, balance problems, facial numbness and tingling, facial nerve paralysis, headaches, and mental confusion. In rare cases it can be life threatening and require immediate medical treatment.

Because symptoms of acoustic neuromas resemble other middle- and inner-ear conditions, they may be difficult to diagnose. Preliminary diagnostic procedures include an ear exam and a hearing test. A magnetic resonance imaging (MRI) scan may help to determine the tumor’s location and size. Early diagnosis offers the best opportunity for successful treatment. Treatment is determined based on age, overall health, medical history, tumor size, hearing ability, and expectations for disease progression. Treatment may include observation with serial imaging, microsurgery, or stereotactic radiation (Gamma Knife).

Meningioma

Meningioma is a tumor that grows in the meninges (layers of tissue that cover the brain and spinal cord). They are usually benign so, unlike cancerous tumors, they don't tend to spread to distant parts of the body. Meningioma tumors occur more often than cancerous brain tumors. They are often discussed alongside brain tumors and can cause neurological problems. As these tumors grow, they can compress the brain and spinal cord, leading to serious complications. Children rarely get meningiomas tumors, and they are more common in older adults. Women are more likely to get them than men.

The underlying cause of meningiomas is not clear. In most people, meningioma tumors grow quite slowly and don’t cause symptoms. In these cases, “watchful waiting” means new symptoms should be documented and scans will be conducted on a regular basis.

Symptoms may not develop until the tumor has become large. Symptoms vary based on the tumor’s location and can include vision or hearing loss, seizures, trouble thinking clearly, trouble walking, loss of smell, weakness in an arm or leg, headaches, or nausea.

Meningioma is diagnosed with an MRI, CT scan, or biopsy. Stereotactic radiation or microsurgical removal is recommended when symptoms are severe, or the tumor is growing. In some cases, like if the tumor is too close to a vital brain structure or blood vessel, surgical removal may be too risky. Meningioma may grow back after surgery, so radiation therapy may be recommended to help prevent another meningioma from developing. If the surgeon can't remove the tumor or can only remove part of it, radiation therapy may be recommended.