Skull base disorders encompass a range of conditions that affect the complex region at the base of the skull.
Our focus is on four key conditions: pituitary adenomas, cerebrospinal fluid (CSF) leaks, post-traumatic facial nerve compression, and severe vertigo requiring labyrinthectomy.
Pituitary adenomas are benign tumors of the pituitary gland, which can affect hormone production and cause nerve compression
Sypmtoms include headaches, vision problems, and hormonal imbalances like milk discharge, menustral irregularities and acromegaly.
MRI and CT :Detailed imaging to assess tumor size,location and how to approach
Hormonal Testing: Blood tests to evaluate hormone levels like prolactin, growth hormone .
Vision Testing: Ophthalmologic evaluation to check for visual field defects.
Surgical Removal: Endoscopic transsphenoidal surgery to remove the tumor.
Medication: Hormone therapy to manage symptoms.
Radiation Therapy:For tumors that cannot be completely removed surgically.
CSF is the fluid covering brain and also occupying space in brian
when CSF leaks through a defect in the base of the skull into the nose its CSF Rhinorrhoea
leaks can be from a single site or multiple
CT scan , MR cysternography: needed to identfy the site of leak
Beta-2 Transferrin Test: A lab test specific for CSF detection.
- **CT Scan or MRI:** Imaging to locate the leak. - **Beta-2 Transferrin Test:** A lab test specific for CSF detection. - **Intrathecal Fluorescein:** Dye injection to identify the leak site during imaging.Conservative management: Bed rest, stool softeners, diuretics
Surgical repair: if consevative managemnt fails there is need for endoscopic repair
Incases where the pressure of CSF is high there might be need for continuous lumbar drainage for a brief period
Facial nerve compression following trauma to the skull usually side can lead to facial paralysis total or partial
Decompression surgery relieves the pressure on the nerve usually due to fracture bone segment to help in recovery of nerve function
-HRCT temporal bone - to look for bone segment pressing on to the nerve
EMG to assess the extent of injury and plan on need and timing of surgery
Conservative mangement: by systemic steroids
Phyiotherapy: to stimulate and retsore the muscular activity
Surgical: Presence of bone pressing on nerve needs to addressed or complete transection or not responding to conservative management
A labyrinthectomy is a surgical procedure for patients with severe, debilitating vertigo that has not responded to other treatments.
it is removed at removing or ablating the sensory organ for balance
it can a chemical or surgical both can lead to permenent deafness
Chemical is by intratympanic gentamicin injection
Surgical by drilling out the bony labrynth