Skull-based tumors are not a single type of brain tumor. Their location defines the type: whether within the bones of the skull that form the bottom of the head or the bones behind the nose and eyes. Most skull base tumors grow inside of the skull, but some form on the outside.

Treating skull base tumors and conditions requires the skill and experience of a center like Sylvester Comprehensive Cancer Center. These tumors are very close to nerves and blood vessels in the brain, head, neck, and spinal cord.

Tests

During the diagnostic stage, we will discover where the tumor is, how big, its spread if any, and details including if the tumor is benign, malignant, a primary, or secondary tumor.

• Benign tumors are non-cancerous, but they can grow and press on nearby areas of the brain or spine. They may severely impair brain or spinal cord function. They rarely spread into other tissues, but they can recur (come back).
• Primary tumors are those that started in the brain or spine. Primary tumors may spread to other parts of the brain or spine. They rarely spread to other parts of the body.
• Secondary, or metastatic tumors started somewhere else in the body, then spread to the brain or spine. These tumors are more common than primary brain tumors.

Neurological Exam
Questions and tests to check the brain, spinal cord, and nerve function are called a neurological exam, neuro exam or neurologic exam. Your mental status, coordination, ability to walk, reflexes, and muscles are measured.

Visual Field Exam
Surgery is the most common treatment for pituitary gland tumors. About 95 percent of surgeries to remove pituitary gland tumors are done by the transsphenoidal route, through the nasal passages and sinus cavity. This surgery is called a craniotomy. Craniotomy procedures can be done using a microscope or an endoscope.

Tumor Marker Test
Tissue, blood, and urine samples are reviewed for substances related to various cancers. These are called tumor markers.

Gene Testing
A sample of blood or tissue gets viewed in a laboratory. Our experts look for any changes in chromosomes linked to certain brain tumors. We can also diagnose an inherited syndrome.

Computed Tomography (CT or CAT Scan)
This procedure makes a series of detailed pictures of areas inside the body from different angles. A colored dye may be injected into a vein or given as a liquid. The dye makes tissue or organ abnormalities show up clearly. Computed tomography, computerized axial tomography, and computerized tomography are other names for this test.

Magnetic Resonance Imaging (MRI)
This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells, so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRI is often used to diagnose tumors in the spinal cord. Sometimes a procedure called magnetic resonance spectroscopy (MRS) is done during the MRI scan. An MRS is used to diagnose tumors, based on their chemical make-up.

Single Photon Emission Computed Tomography (SPECT) Scan 
In this diagnostic test, a special camera is linked to a computer to make a 3-dimensional picture of the brain. Safe amounts of a radioactive substance are injected with a needle or given through the nose and inhaled. The camera rotates around the head. Pictures show us where blood or bodily fluids are flowing abnormally. Cancer cells can be the cause of this and we identify those locations.

PET Scan (Positron Emission Tomography Scan) 
You will lie down on the PET scan machine, as the PET scanner rotates around your body. Tiny amounts of radioactive sugar (glucose) are injected into a vein. The PET scanner makes pictures of where cells in your brain are using the glucose as energy more than in other areas. These are likely cancer cells because they are more active than healthy cells.

Biopsies
Biopsies help determine if a pituitary cancer tumor is cancerous. Biopsies are performed with imaging help from an ultrasound, CT or MRI. A pathologist checks the biopsy sample to find out the tumor type and grade (how quickly the tumor may grow or spread). 

• Stereotactic Biopsy: This test looks at tumors deep in the brain. We use a computer and 3-D scanning device. The image allows us to guide the needle used to remove the tissue. A small incision made in the scalp allows the surgeon to insert the biopsy needle to remove cells or tissues. The cells and tissue are viewed under a microscope by a pathologist.

Treatments

Your recommended treatment is based on your exact case and test results. Our multidisciplinary experts will work as a team to offer a personalized approach leading to the best potential outcomes. Treatments for skull base tumors include:

Surgery
Surgery removes tumor tissue to decrease pressure on nearby parts of your brain. Your surgeon will try to remove all cancer seen at the time of the surgery. Remaining cancer cells following surgery are treated with chemotherapy or radiation therapy.

Radiation Therapy
Radiation therapy kills cancer cells or stops them from growing. High energy X-rays, gamma rays, or proton beams shrink a tumor before surgery. Or it may be done to kill any cancer cells left after surgery. Radiation therapy may also be used as the main treatment if surgery is not an option. It can also help relieve symptoms caused by a tumor. There are two main types of standard radiation therapy:

• 3-Dimensional Conformal Radiation Therapy (3-D CRT): A computer creates a 3-D picture of the brain or spinal cord tumor. These images help us to focus higher doses of radiation at the tumor.
• Intensity-Modulated Radiation Therapy (IMRT): This is also a type of 3-D radiation therapy. It uses thin beams of radiation of different intensities (strengths). The beams hit the tumor from many angles.
• Stereotactic Radiosurgery: Therapy that aims a single large dose of radiation directly at a brain tumor. Also called stereotactic radiosurgery and radiosurgery. It is not technically a surgical procedure.
• Gamma Knife® Radiosurgery: Focuses one large dose of radiation to small tumors (less than 3 centimeters) with pinpoint accuracy.

Chemotherapy
Chemotherapy uses drugs to kill the cancer cells or stop them from growing and spreading. Chemotherapy after surgery or biopsy is called adjuvant chemotherapy. Chemotherapy may be injected as a liquid into a vein or muscle using an IV (short for intravenous); taken orally by mouth, as pills; or delivered right into the fluid-filled space around the brain.

• Intrathecal Chemotherapy: A wafer that dissolves delivers an anticancer drug directly to the brain tumor site post-surgery.

Targeted Therapy
Targeted therapies use newer drugs that can identify and attack very specific cancer cells. They may also be used to treat blood vessels near the tumor. Target therapy is sometimes chosen as a therapy when surgery is not an option. Examples of targeted therapies are monoclonal antibody therapies such as Bevacizumab. This therapy may prevent the growth of new blood vessels that tumors need to grow. Bevacizumab treats recurrent glioblastoma.

Supportive Therapies
Supportive therapies are often provided to lessen problems or side effects caused by the disease or its treatment. They may also be given to help improve your quality of life. For brain tumors, supportive care includes drugs to control seizures, fluid buildup or swelling in the brain.

Clinical Trials
Clinical trials focus on finding improved ways to treat brain and neurological cancers. If you are eligible, your doctor at the Sylvester Cancer Center will explain options for you to consider.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

One of only six designated Cancer Centers of Excellence in Florida. We treat cancer, and only cancer, giving you the best potential outcomes. Your likelihood of surviving cancer at least five years after treatment is 17 percent higher when treated at a Dedicated Cancer Center than at other hospitals.

Advanced radiation oncology tools. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.

More options for treatment-resistant tumors. If chemotherapy or radiation therapy do not work for your cancer, we will explore the newest clinical research breakthroughs to help you beat cancer.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with easy access to the very newest ways to treat and potentially cure your cancer.