Medical Oncologist
CION Cancer Clinics
What skull base surgery for cancer involves | CION Cancer Clinics
Skull base surgery removes a tumour from the floor of the skull, behind the nose, eyes and ears. The surgeon reaches it through the nose with a thin camera, through a cut on the scalp or face, or both. It is a long operation done by a team. This page explains the routes, the pathway from scans to home, the red flags afterwards, and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is skull base surgery, and what actually happens?
- Which way will the surgeon reach the tumour?
- What happens from the first visit to going home?
- What do the words on the report mean?
- What do families often believe, and what is true?
- What can this page not tell you?
- Common questions about skull base surgery
The short answer
What is skull base surgery, and what actually happens?
Skull base surgery removes a tumour from the floor of the skull, the bony shelf the brain rests on, which sits behind the nose, eyes and ears. The surgeon reaches it through the nose with a thin camera, through a cut on the scalp or face, or through both together.
Why it is a team operation
The skull base is where the brain, nose, sinuses, eye sockets and ears meet, with nerves and blood vessels passing through small holes in the bone. No single surgeon covers all of that. The operation brings together a head and neck surgical oncologist, an ENT surgeon and a neurosurgeon, and sometimes an eye or plastic surgeon.
Which cancers lead here
Most often it is a cancer that began in the nose or sinuses and has grown up towards the base of the skull. Less often it is a cancer of the ear canal, a tumour of the bone or nerves of the skull base itself, or a skin cancer that has travelled inward along a nerve.
Many growths near the skull base are not cancer. Some pituitary and nerve tumours are benign, and their pathway is different from the one described here.How the surgeon gets there
Which way will the surgeon reach the tumour?
The route is chosen by where the tumour sits and how far it has grown.
Through the nose
A thin telescope with a camera and fine instruments passes up through the nostrils. There is usually no cut on the face.
Usually suits
- Tumours in the middle of the skull base
- Tumours that have not spread far to the sides
Through the scalp or face
A cut is made behind the hairline, beside the nose or in front of the ear. A window of bone is lifted out and fixed back at the end.
Usually suits
- Tumours growing into the eye socket or skin
- Tumours reaching far to the side
Both together
The team works from below through the nose and from above through the scalp. It is used when one route alone cannot reach every edge of the tumour safely.
From the side, around the ear
For cancers of the ear canal and the bone around it, the approach is from the side of the head. This has its own page on temporal bone resection.
Not sure whether this applies to you?
Ask an oncologistThe pathway
What happens from the first visit to going home?
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Scans and a biopsy
You will usually need a CT scan, which shows the bone, and an MRI, which shows how close the tumour is to the brain and nerves. A small piece of tissue confirms the diagnosis before anything is planned.
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Tumour board
Surgeons, radiation oncologists and medical oncologists look at your case together. They decide whether surgery should come first, or whether radiotherapy or chemotherapy suits better.
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Fitness checks
Blood tests, a heart and lung check and a meeting with the anaesthetist. Tell them about every medicine you take, including blood thinners.
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The operation
You are fully asleep. These are long operations, often most of a day. At the end the team repairs the floor of the skull so the fluid around the brain stays sealed in.
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The first days
Usually in intensive care or a high-dependency bed first, where nurses check your vision, alertness and nerves often. You may have a pack in the nose or a drain.
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Going home and after
You go home once you are eating, walking and the repair is holding. The final tissue report comes later and decides whether radiotherapy follows.
On your report
What do the words on the report mean?
- Skull base
- The bony floor of the skull, running from behind the eyes to behind the ears.
- Anterior, middle, posterior
- The front, middle and back parts of the skull base.
- Dura
- The tough lining around the brain. If the tumour involves it, part of the lining may be removed and patched.
- Margin
- The rim of normal tissue removed around the tumour. At the skull base a wide margin is not always possible without harming a nerve.
- CSF leak
- Clear fluid from around the brain dripping out through the nose. The repair at the end of surgery is there to prevent it.
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One thing that cannot wait
After skull base surgery, clear watery fluid dripping from the nose, especially when you bend forward, needs a call to the surgical team the same day. So does a severe headache, a fever with a stiff neck, new confusion or a sudden change in vision. If you cannot reach the team, go to the nearest emergency department and tell them about the operation. Do not blow your nose hard while you wait.
Commonly believed
What do families often believe, and what is true?
"Operating near the brain means opening the head."
Not always. Many tumours can now be reached through the nose, with no cut on the scalp. Whether that is possible depends on where the tumour is and how far it has spread.
"Once it is removed, no more treatment is needed."
Many people with a skull base cancer have radiotherapy after surgery, and some have chemotherapy too. The decision waits for the final tissue report, which shows how close the cancer came to the edges of what was removed.
"This surgery always leaves the face paralysed or the person blind."
These are real risks. How likely they are depends on which nerves the tumour touches. Some tumours cannot be removed without giving up a nerve, and you should be told that before the operation, not after it.
"Radiotherapy alone is the gentler option, so we will ask for that."
For some tumours radiotherapy is the main treatment. For others it controls the cancer less well than surgery followed by radiotherapy. Ask what each option is expected to do for this particular tumour.
Being straight with you
What can this page not tell you?
This page cannot tell you whether surgery is right for you or your parent. That depends on the type of tumour, exactly where it sits, which nerves and vessels it touches, and how fit the person is for a long operation. Your treating team weighs all of that together.
Who it does not suit
Surgery is not usually offered when the cancer has grown deep into the brain or around the main blood vessels, when it has spread to distant organs, or when the heart or lungs would not cope with a long anaesthetic. Some cancers, such as certain lymphomas and some cancers at the back of the nose, respond so well to radiotherapy or chemotherapy that surgery is not the first choice.
Questions worth taking to the appointment
Ask which route is planned and why. Ask which nerves are at risk and what would change if one were harmed. Ask whether radiotherapy is likely afterwards, how long the hospital stay will be, and who you call at night once you are home.
Questions we are asked
Common questions about skull base surgery
How long does skull base surgery take?
It varies a great deal with the size and position of the tumour. A smaller operation through the nose may take a few hours. A combined operation through the nose and scalp can run for most of a day. The surgeon will give you an estimate beforehand.
Will there be a scar on the face?
Not if the whole operation is done through the nose. Open approaches usually use a cut behind the hairline, which is hidden once the hair grows back, or a cut beside the nose or in front of the ear that follows a natural crease. Ask your surgeon to show you exactly where the cut will be.
Will my father lose his sense of smell?
It depends on where the tumour is. Tumours in the roof of the nose sit right where the smell nerves are, and removing them often means losing smell for good. Operations further back may leave smell weaker while the nose heals, and it can then partly or fully return. Ask about this directly before surgery.
How long will the hospital stay be?
Anything from several days to a couple of weeks, depending on the size of the operation and how the repair holds. The first night or two are often in intensive care. Going home is decided by eating, walking, a settled wound and no sign of fluid leaking from the nose.
Is it safe to operate so close to the brain?
Every skull base operation carries real risks. These include a leak of brain fluid, infection, bleeding, and harm to nerves that control sight, facial movement, swallowing or hearing. Your surgeon should explain which of these apply to this tumour. The team weighs those risks against what the tumour is likely to do if it is left.
Will radiotherapy be needed afterwards?
Often, yes. Skull base cancers sit close to nerves and vessels that stop the surgeon taking a wide rim of normal tissue, so radiotherapy is used afterwards to treat any cells left behind. The decision is made once the final tissue report is back, usually at a second tumour board discussion.
When can I go back to work?
It depends on the operation and the job. Desk work is often possible sooner than heavy lifting, which strains the repair at the skull base. Many people also have radiotherapy after surgery, which brings its own tiredness. Your surgeon will tell you when bending, lifting and flying are safe for you.
Is it covered by Aarogyasri or insurance?
Cancer surgery is often covered under Aarogyasri, CGHS, ECHS, EHS and most cashless insurance policies, subject to each scheme's rules and approval. Call the helpline with your card or policy details, and the team will check what applies before admission.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
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Sources
- National Cancer Institute — Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ) - Patient Version
- NHS — Nasal and sinus cancer
- Cancer Research UK — Nasal and sinus cancer
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Open vs endoscopic skull base approachesHow the team chooses between the nose and the scalpEndoscopic endonasal surgery explainedThe operation done entirely through the noseCSF leak after skull base surgeryThe complication behind the red flag on this pageRecovery after skull base surgeryThe weeks after going homeSkull Base and Temporal Bone ResectionEvery page in this guide
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