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Under your skull, between your brain and the top of the neck, is an area called the skull base. The space is home to a platform where the brain sits. It¡¯s also home to other important structures like blood vessels, nerves and your spinal cord.?These nerves play an important role in how you see, hear, speak, swallow, breathe, taste and smell.

Skull base tumors can be anywhere inside this cavity. Because they can be so broad, there are many myths surrounding skull base tumors.

Skull base tumor surgeon , debunks four of them.

Myth 1: A bump on your skull is a symptom of skull base tumor.

Fact: Since the skull base is within the helmet of your skull, you won¡¯t be able to feel a tumor the way you might be able to feel a swollen lymph node or a tumor in another part of your body.

Instead, when skull base tumors grow, you¡¯ll experience symptoms caused by the tumor pressing against other structures inside your skull.? ?

Blurry vision, double vision or changes in your perception of color could be symptoms of a tumor near your optic nerves.

If a tumor is pressing on the ears, you may feel dizzy, have trouble hearing or experience ringing in your ears. Tumors in the sinus cavity can affect your sense of smell or cause symptoms that mimic the common cold or a sinus infection.

Nerves in your skull control a lot of other major functions, including talking, walking and swallowing. Skull base tumors near these nerves can impact each of these functions.?

?Sometimes skull base tumors can affect your pituitary glands, which disrupt hormones. In women, this may cause irregular periods.

Since these symptoms can be signs of less serious conditions, it¡¯s important to talk to your primary care doctor if you¡¯re experiencing them without relief for more than two weeks.

Myth 2: All skull base tumors are cancerous.

Fact: Skull base tumors can be either cancerous or benign. The most common skull base tumor, meningioma, isn¡¯t cancerous. Acoustic neuromas are also benign.

These benign tumors are often diagnosed by accident. For example, if a patient has an accidental fall and gets an MRI, they may learn about a tumor.?

Whether or not your tumor is cancerous, it¡¯s important to get the right diagnosis so you can get the right treatment and avoid long-term problems.

Myth 3: Skull base tumors aren¡¯t curable.

Fact: The truth is, there isn¡¯t an area of the skull base that we can¡¯t treat.

But that wasn¡¯t always the case. Until the early 1990s, skull base surgery wasn¡¯t even classified as a specialty. Brain surgeons used to go as far down as they could go, and head and neck surgeons would go as far up as they could go. But there weren¡¯t any skull base experts to surgically remove these tumors.

Now, MD Anderson is home to a world-renowned Skull Base Tumor Program with seven surgeons specifically dedicated to skull base tumors. But surgery is just one part of the equation.

We¡¯ve also established less invasive surgical techniques, which limit our contact with the brain, reducing the risk of side effects. The goal is to get rid of the tumor while preserving the patient¡¯s quality of life.?

Radiation therapy, including proton therapy, is emerging as an effective way to treat some tumors and reduce or even eliminate the need for surgery.

Chemotherapy, immunotherapy and targeted therapies are also options for shrinking tumors before surgery and radiation.

Sometimes, we may not even treat a tumor. At least, not right away. Some benign skull base tumors are slow growing and don¡¯t cause any other problems. In those cases, surgery to remove the tumor could cause more problems than the tumor itself. ?

There are also other specialists that help patients recover from skull base tumor treatment. These include plastic and reconstructive surgeons, speech and swallowing therapists, dental and oral surgeons, and other experts depending on the area of the tumor and the treatment.

Myth 4: You can go anywhere for skull base tumor treatment.

Fact: Your life depends on where you go first for skull base tumor treatment. We often see patients at MD Anderson who¡¯ve been misdiagnosed. When you don¡¯t get the right diagnosis, you can¡¯t get the right treatment. And unfortunately, if you start with the wrong treatment, your future treatment options may be limited.

It¡¯s understandable to want to seek care close to home or with a doctor you¡¯re familiar with, but expertise matters ¨C especially with rare diseases like skull base tumors. But getting the right treatment the first time is key to overcoming skull base tumors.

At MD Anderson, we see hundreds of skull base tumors every year, and we have clinical trials dedicated to creating more effective treatment options for patients.

Even if it may take more time to get an appointment, taking the time to get the right diagnosis before you start treatment is the best way to ensure you get the right treatment and the fastest route to recovery.

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As a surgeon, I am motivated by the challenge skull base tumors represent ¡ª both their complexity and the impact that they have on our patients. Because not that long ago, many of these tumors were considered incurable.

Before skull base surgery was developed as a field, neurosurgeons would go as low as they could go, and head and neck surgeons would go as high as they could go. Both would stop at the skull base ¡ª the bony platform behind the eyes and nose that slopes down toward the back of the head. That meant sometimes part of a tumor got left behind ¡ª where it could grow right back.

Today, we know that skull base tumors are curable. It takes many types of brain and spine and head and neck specialists working together to treat them effectively. But we do that here at MD Anderson. And being involved in that process is the most rewarding part of my job.

Why skull base tumors are difficult to diagnose

Skull base tumors are rare, so they are often difficult to diagnose. The average doctor will probably see less than a handful in their entire career. That¡¯s why it¡¯s important to seek treatment at a place like MD Anderson ¡ª because even rare tumors aren¡¯t rare here.

Patients frequently come to us with a particular diagnosis, but when we review their reports with our dedicated head and neck and neuropathologists, we sometimes come to a different conclusion. This happens more than 30% of the time. So, for one out of every three skull base tumor patients, we say, ¡°Nope. You have this instead of that.¡±

One reason is that there are many different types of skull base tumors. They can originate in the head or neck (nasal, sinuses, ear or salivary gland), in the brain (meningioma, chordoma, acoustic neuroma or pituitary gland), or in the skull base itself (usually sarcoma). Not all of them are cancerous. But all of them can affect a patient¡¯s most basic functions, such as breathing, eating and walking.

• Related: Skull base tumor symptoms

Successful skull base tumor treatment requires multidisciplinary care

Regardless of the type of skull base tumor, they¡¯re all difficult to treat, because of their location deep inside the head. This makes them challenging to access. The skull base involves many vital structures, such as major blood vessels and nerves that control vision, hearing, balance and gait. So, skull base tumors can¡¯t be resolved by a simple surgery or a single specialist.

At MD Anderson, a skull base tumor patient may see a neurosurgeon, a head and neck surgeon, a temporal bone surgeon, a plastic surgeon and an ophthalmologic surgeon. They may also have a medical oncologist, a radiation oncologist, a neuro-oncologist, and a head and neck medical oncologist.

That¡¯s what makes our multidisciplinary approach to care so critically important. Every member of a patient¡¯s team has to work together with all the others to provide the best possible result. And we do.

How MD Anderson is advancing skull base tumor treatment

One area in which MD Anderson has really led the way is in developing and pioneering a ¡°minimal access¡± approach to skull base tumors. In these procedures, surgeons use natural passages (such as the sinuses or nasal cavity) to reach these growths, instead of making cuts to the face or removing large sections of bone from the skull. This is a huge advance for our patients, as it means fewer extreme surgeries and shorter recovery times.

Through clinical trials, we¡¯re also exploring how delivering treatments such as chemotherapy or immunotherapy first can improve results by reducing the size of a tumor or requiring less surgery.

we published earlier this year on sinonasal undifferentiated carcinoma is revolutionizing the way that type of cancer is being treated. The study found that patients who received chemotherapy and radiation therapy before surgery had much higher survival rates five years after diagnosis than those who received surgery first. These findings are changing the way this disease is treated both here at MD Anderson and globally.

Where you go first for skull base tumor treatment matters

Skull base tumors are curable. But it¡¯s much harder to treat them when you¡¯re dealing with a cancer that has come back or one that never really went away to begin with. So, getting the right treatment up front makes all the difference. Your chances of survival are higher, and your results and quality of life are better.

That¡¯s why, for me, performing surgery on patients with skull base tumors today is far more than just a technical exercise in removing cancer from a difficult area.

It¡¯s about stepping into someone¡¯s life at a very vulnerable point ¡ª possibly the most-vulnerable point ¡ª and guiding them safely through the storm.

, is vice chair of Head and Neck Surgery at MD Anderson and co-director of the Skull Base Tumor Program.

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I have suffered from migraines for 30 years. And to cope with the pain, I enjoy journaling. It helps me to distract myself and find clarity. My words have turned into songs that could help others experiencing similar pain.

I even joined a songwriters¡¯ group where I collaborate with others who share the same interests. Over the years, writing and singing have given me strength to let go and be free of the pain in my head.

But in December 2019, something changed. I started to notice my headaches felt different. It hurt to exercise, stand up or even get out of bed. I also began having balance issues.

I¡¯m a veteran, so I went to my local VA hospital in New Orleans, Louisiana. An MRI showed a skull base tumor -- a benign neoplasm of cerebral meninges.

My doctor recommended we wait and see how the tumor progressed because surgery would cause more harm than good. By March 2020, I started experiencing tingling and pain on one side of my face. I knew it was time for a second opinion.

Finding connection and compassion at MD Anderson

I researched cancer centers near me and found MD Anderson. I learned that specialized in treating skull base meningiomas like mine. He was from northern Italy, where I¡¯d spent three years in the military. I had even written a song in English and Italian about my life called ¡°Lash¡¯Andare.¡± This song explains how even through the pain, I needed to learn to let go.

Once I arrived at MD Anderson and met with my care team, I felt I was right where I was supposed to be. Dr. DeMonte and rheumatologist found answers to problems I knew were going on but hadn¡¯t been diagnosed.?Dr. Buni diagnosed me with osteopenia, which was the reason I had pain in my joints, making it hard for me to move around. She also found a cyst behind my knee.

For the first time, I felt hope. This was the best team of medical professionals who specialized in treating my type of skull base tumor.

Undergoing radiation therapy for my skull base tumor

In June 2020, I began a type of radiation therapy called volumetric modulated arc?therapy (VMAT) treatment at the MD Anderson Proton Therapy Center. The goal was to prevent the brain tumor from progressing.

The staff at the front desk of the Proton Therapy Center always made me feel at home when I arrived.

My radiation oncologist was , and stepped right up when needed. They both made me feel comfortable and treated me with compassion throughout radiation therapy.

I was nervous for my first radiation treatment. But my radiation therapist Esmeralda Gonzalez helped me relax. And that made my next 29 treatments go smoothly. Getting used to the routine of radiation helped ease my fears of the unknown.

But it wasn¡¯t just my care team that gave me hope. Because my treatments lasted almost seven weeks, with appointments in several locations each day, the shuttle drivers became impactful in my MD Anderson experience. They were so kind and funny. Their stories kept me in good spirits throughout the day.

Looking back with gratitude and forward with hope

I was lucky to find a rental house in Houston with a wonderful landlord who let me bring my three dogs and two cats. Being able to have my animals with me while being away from home brought me a lot of comfort. Some friends I¡¯d met in Italy also came to stay with me and keep me company. I met so many great people in Houston while I was there.

At my last treatment, I had hoped to sing at the Proton Therapy Center to encourage other patients, but I couldn¡¯t due to COVID-19 precautions. My hope is to keep sharing my brain tumor experience -- and my songs -- with others. I want to be a positive light in their healing, just as so many have done for me.

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I¡¯ve been an educator for 16 years and a high school librarian for eight. I teach kids how to do research, so I know how to find stuff online. And that¡¯s exactly what I did after my husband, Mark, was diagnosed with a rare skull base tumor?called chordoma of the clivus last summer.

None of the doctors or specialists we saw here in Alabama could even tell us what it was, much less how to treat it. One thought it might be an infection. All of them called it ¡°inoperable,¡± which meant they »å¾±»å²Ô¡¯³Ù think it could be removed surgically. They suggested we go home and get Mark¡¯s affairs in order, because whatever he had was probably going to kill him.

At the time, our son was only 3. So, that prognosis was not OK with me. I started researching. And the one name that kept popping up was MD Anderson. I have one dear friend who works there and another who received treatment there. So, I¡¯d already heard it was a fabulous place. It also has an entire team focused on skull base tumors, like my husband¡¯s.

Now, after seeing firsthand what MD Anderson did for Mark, I know my friends were right. When it comes to cancer, MD Anderson is a whole different ball game. No one can beat it.

A better prognosis after a skull base tumor diagnosis

After three weeks of being ping-ponged back and forth between local doctors who told us Mark was probably going to die, I was completely freaking out. Then we met with , a neurosurgeon at MD Anderson. After completing his examination, he said, ¡°Not only do I know what this is, but you¡¯re the second patient I¡¯ve seen with it this week. And, yes, it¡¯s rare. But you¡¯re going to be OK.¡±

Dr. Raza said Mark¡¯s tumor was a chordoma of the clivus. He would need a 10-hour surgery to remove it from the skull base. Then he¡¯d need eight weeks of proton therapy under . After that, Dr. Raza told Mark, ¡°You¡¯re going to go on and live a long life.¡±

Hearing that was like having an elephant get up after sitting on your chest. For three weeks, I hadn¡¯t been able to breathe. We were like, ¡°OK. What?¡± Because we¡¯d come in that day thinking Mark¡¯s tumor was inoperable. And here we were, leaving with a surgery date. So, not only did Dr. Raza give us a plan, he also gave us hope.

My husband¡¯s skull base tumor surgery

Mark¡¯s procedure took place on Dec. 5, 2018. Having a loved one in surgery for 10 hours is nerve-wracking, to say the least. But the entire staff at MD Anderson was incredible ¡ª just phenomenal. They kept Mark very comfortable the whole time and made sure I was well-informed at every step.

In fact, one of the reasons I »å¾±»å²Ô¡¯³Ù freak out so much is because I knew exactly how the surgery was going to go. Dr. Raza and , Mark¡¯s head and neck surgeon, gave me a detailed description beforehand. The first part would be Dr. Su clearing a path to the tumor for Dr. Raza through the sinuses. The next would be Dr. Raza actually removing the tumor. And the final part would be Dr. Su closing the incisions back up. I¡¯d know everything was going smoothly and according to plan by which doctor was giving me the update. That was a big-time relief.

Life after skull base tumor treatment

The hardest part of Mark¡¯s diagnosis and treatment was having to be away from him for so long. I¡¯ve got a great support system at home and we both have very supportive workplaces. But the eight weeks he spent getting proton therapy was the longest we¡¯ve ever been apart in our 17 years together.

It was tough, knowing Mark would be by himself for that. But I had to stay home and take care of our son. So, we set Mark up in a temporary apartment in Houston and made plans for people to visit him. That way, he¡¯d never go more than two weeks without having family around him.

Mark finished his cancer treatment on Feb. 28, 2019. And he¡¯s shown no evidence of disease since then. He has to go back for check-ups every four months, but that¡¯s OK.

Dr. Raza was able to remove every part of the tumor he could see, which reduces the chances of recurrence. And statistically, that¡¯s the most positive scenario you can have. There¡¯s still a 50% chance that Mark¡¯s tumor will come back someday, so we¡¯re always going to be a little on edge. But knowing MD Anderson has given us the best shot possible is a huge relief.

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Until a few years ago, my father was the only person in my family who¡¯d ever had cancer. In 1997, he was diagnosed with mesothelioma, which is almost always caused by exposure to asbestos.

My dad developed the disease in his lungs after working in the electrical services industry for 20 years. By the time he was diagnosed, the cancer had already spread to his brain. My father died of complications of mesothelioma in 1999, at age 50.

I¡¯ve worked in health and education for most of my professional life, so as far as I know, I¡¯ve never been exposed to asbestos. I never thought I¡¯d receive a cancer diagnosis of my own. But life can change in a moment. Mine did in October 2017.

My skull base tumor diagnosis

I¡¯d been seeing my family doctor for about nine months to treat what I thought was a stubborn sinus infection. But it kept getting worse, even after several rounds of antibiotics and oral steroids. I couldn¡¯t breathe out of the right side of my nose. I was getting bad headaches, too.

My doctor referred me to an ear, nose and throat specialist. He ordered a CT scan and an MRI, which showed a growth in my sinus cavity. The next day, he ordered a biopsy.

It took two and a half weeks and several different medical labs to get a concrete diagnosis. When the results finally came back, my ENT gave me the news: I had esthesioneuroblastoma, also known as olfactory neuroblastoma. It¡¯s a rare type of skull base tumor that starts in the sinus cavity and grows toward the brain.

• Related topic: Skull base tumor symptoms

Choosing MD Anderson for skull base tumor treatment

A skull base tumor diagnosis was a lot to digest. I felt scared, especially since my cancer was so unusual. I was also pretty worried and unsure about what my treatment would entail.

But I knew that I wanted to go to MD Anderson for my skull base tumor treatment. It has a reputation as a highly regarded cancer hospital. And I knew its doctors would have experience with my specific type of cancer, which was important. So I made an appointment, then made the trip from Missouri to Houston.

Life after a skull base tumor

At MD Anderson, we met with sinus and skull base tumor surgeon and radiation oncologist . They recommended surgery to remove the tumor, followed by 32 radiation therapy treatments. Dr. Su explained that the entire procedure would be performed through the nose and I would have no external scars. She performed the surgery on Nov. 20, 2017. I started my radiation treatments in January 2018, and finished the following month. I¡¯ve shown no evidence of disease since then.

I experience some dry mouth now, and I have no sense of smell anymore. My thyroid was a little damaged by the radiation, too, so I¡¯m taking medication for that. And I have to rinse my sinuses a couple of times a day with a saline solution. But other than that, my life is pretty much back to normal. I work full time and play golf and just try to make the most of every day.

Cancer changes your life. But MD Anderson does an exceptional job of treating each and every patient as a valuable human being with a life worth saving. So, I wouldn¡¯t go anywhere else.

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In March 2014, I tried to connect a boat trailer to my minivan, ploughed head-first into the closed tailgate and really hurt my neck.

An X-ray showed I hadn¡¯t broken my neck, but the doctors saw something near the back of my brain, at the base of my skull. A CT scan confirmed it was a tumor. The doctor was elated because he found it before I had any symptoms. I had mixed emotions, and it took a while to process the news.

After many tests and several weeks in the hospital, we knew I had a tumor in my skull, at the base of my brain on the right side. But even after two needle biopsies, the doctors couldn¡¯t diagnose the type of tumor or decide how to treat it.

Within 14 months, I¡¯d begun experiencing major symptoms -- constant pain in my neck and head, weak legs, and an inability to walk or rise from a chair without assistance. Even a gentle cough could cause me to pass out if I »å¾±»å²Ô¡¯³Ù lie down immediately. One day, the symptoms »å¾±»å²Ô¡¯³Ù go away after I coughed. I ended up having emergency surgery to install a ventriculoperitoneal shunt to relieve pressure from the cerebrospinal fluid buildup in my brain caused by the tumor.

Afterwards, I finally received a diagnosis: clear cell chondrosarcoma. The neurosurgeon stated that the best he could do was to surgically remove some of the tumor and move me to the palliative ward.

On the road to skull base tumor treatment at MD Anderson

A friend who happened to be a retired physician researched treatments and facilities for me. Within two weeks, we were driving from Canada to MD Anderson in Houston, Texas, to meet a highly skilled skull base neurosurgeon named

But before we made it to Houston, things went horribly wrong. In Salina, Kansas, I started vomiting every 20 minutes, and my head felt like it would split open. It turns out my medications had caused bleeding in my brain.

When we finally arrived in Houston on Oct. 20, 2015, I was admitted to MD Anderson¡¯s Emergency Center.

A new diagnosis and skull base surgery

After DeMonte reviewed my medical data and MD Anderson¡¯s pathologists reviewed my biopsies, they gave me a new diagnosis: small cell osteosarcoma, bone cancer in the base of my skull.

We felt relieved when we heard those amazing words: ¡°This looks curable.¡±

By early November, I¡¯d recovered from the debilitating brain bleed, moved from the ICU to the neuro floor, and was ready for surgery. Five very talented MD Anderson surgeons and their respective medical teams spent 13.5 hours removing a very large tumor from the base of my skull and my cerebellum and brainstem.

They separated the tumor from several cranial nerves, around which it had grown without any negative impact on the nerves themselves. It was a very major and technically difficult operation, performed by dedicated physicians under very difficult circumstances. I will likely never realize the full severity and difficulty of the surgery. But I do know one thing: God was in control from the beginning, and oversaw every step that was taken.

Safely through the flames

In December 2015, after 46 days in the hospital at MD Anderson, we made the five-day, 2,500-mile drive back home to Canada. In January 2016, I began chemotherapy in Seattle, Washington ¨C just 2.5 hours from home ¨C overseen by an oncologist who had completed a fellowship at MD Anderson. The chemotherapy successfully shrank the small piece of tumor that remained in the petrous apex region of my skull base.

When I look back on my journey, I can¡¯t help but feel gratitude for making it safely through the flames.?I¡¯m now back at work, and I just had my chemotherapy port removed. I have CT scans and MRIs every three months and return to MD Anderson periodically for follow-up care. Everything is clear, and all the news I get is good news!

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