Skull base surgery, also called skull base neurosurgery, is performed to remove both benign and malignant growths and abnormalities from the underside of the brain, sinuses and nasal cavities and the top few vertebrae of the spine. This area, known as the skull base, is one of the most complex to operate on because it is difficult to reach and is filled with many nerves that are responsible for hearing, seeing and facial movement. Additionally, the skull base is home to many blood vessels that supply oxygen to the brain and spinal cord.
A multispecialty team of neurosurgeons, ear, nose and throat (ENT) surgeons and many other specialists at Tampa General Hospital’s Neuroscience Institute and Ear, Nose & Throat Institute collaborate to perform skull base surgery. Through the Skull Base Surgery Center and TGH and USF Health Endoscopic Sinus and Skull Base Surgery Program, fellowship-trained rhinologists work alongside neurosurgeons to treat complex conditions affecting the brain, sinuses and nasal cavities using highly specialized, minimally invasive techniques.
As Florida's premier academic health system affiliated with the University of South Florida, TGH is uniquely positioned to implement the latest technological advances that lead to effective minimally invasive approaches to skull base surgery.
Our surgeons’ expertise, research and skill has helped TGH earn ranking as one of the nation’s top hospitals for Neurology & Neurosurgery by U.S. News & World Report for 2026-27, and placement on Newsweek’s World’s Best Hospitals 2026 list.
What Conditions are Treated with Skull Base Surgery?
The skull base region involves both neurologic and sinonasal structures, so a wide range of conditions can be treated through a collaborative neurosurgery and ENT approach, including:
- Acoustic neuromas – Noncancerous tumors that form around certain nerves in the ear
- Pituitary adenoma – These tumors occur behind the nose and eyes and can cause acromegaly in adults
- Meningioma
- Craniopharyngioma
- Chordomas – Slow growing bone tumors generally found at the base of the skull
- Brain aneurysm – A bulging spot in a blood vessel in the brain
- Arteriovenous malformations – Arteries and veins that are connected abnormally
- Trigeminal neuralgia – Severe pain on one side of the face
Sinonasal and skull base conditions treated in collaboration with ENT specialists include:
- Sinonasal carcinomas – Tumors that affect the sinuses and nasal cavities; a subtype includes sinonasal adenocarcinomas
- Olfactory neuroblastoma – Tumors that develop in the upper region of the nasal cavity
- Adenoid cystic carcinoma – Tumors that grow in the salivary glands
- Chronic rhinosinusitis and advanced sinus disease – Long-term inflammation of the nasal passages and sinuses lasting 12 week or longer
- Allergic fungal rhinosinusitis (AFRS) – A severe inflammatory condition caused by a fungal infection in the sinuses
- Cerebrospinal fluid (CSF) leaks – Abnormal openings in the dura mater (the outermost layer of the membrane that protects the central nervous system) that allow fluid surrounding the brain to drain into the sinuses
- Tear duct (nasolacrimal) disorders – Conditions affecting tear drainage pathways near the skull base
- Juvenile nasopharyngeal angiofibroma – A rare, highly vascular tumor typically affecting adolescent males
- Growths resulting from infections
Skull Base Surgery Procedures
There are two main approaches to skull base neurosurgery: endoscopic (minimally invasive) and open skull base surgery. The approach used depends on the location, size and complexity of the condition being treated.
Endoscopic Skull Base Surgery
Endoscopic skull base surgery is a minimally invasive technique performed through the natural openings of the nose. This approach is carried out collaboratively by ENT surgeons (rhinologists) and neurosurgeons, allowing surgeons to access the skull base without external incisions.
During the procedure, an endoscope—a thin, lighted tube equipped with a high-definition camera—is inserted through the nasal passages and guided to the treatment area. Using specialized instruments, surgeons can precisely remove tumors, repair abnormalities and treat conditions affecting the brain, sinuses, orbit and surrounding structures.
This approach is commonly used to treat pituitary tumors, meningiomas, sinonasal cancers and cerebrospinal fluid (CSF) leaks. Following tumor removal or repair, the surgical site is carefully reconstructed, often using tissue from within the nasal cavity to restore normal function and protect the brain.
Open Skull Base Surgery
Although minimally invasive skull base surgery is the preferred method whenever possible, traditional or open base skull surgery is sometimes a patient’s best option for certain complex or large tumors. During this procedure, also known as a craniotomy, incisions are made to the face and skull and pieces of bone are removed to allow the surgeon to access the intended area.
Open approaches may be recommended when a tumor cannot be safely reached through the nose or when broader exposure is required to protect surrounding nerves and blood vessels.
What to Expect with Skull Base Surgery
After skull base surgery, the medical team closely monitors a patient’s progress. Patients who undergo minimally invasive skull base surgery often stay in the hospital for one or two days following the procedure. Those that undergo open skull base surgery may stay in the hospital for about one week. Most patients are typically able to walk the day after surgery and resume light exercises within a couple weeks.
Because many skull base procedures are performed through the nose, some patients may experience temporary nasal congestion, drainage or mild discomfort as the sinuses heal.
Depending on the specific condition being treated, patients may undergo one or more treatments in addition to skull base surgery, such as vascular decompression, nerve stimulation, reconstructive and plastic surgery, radiation therapy and chemotherapy. For example, microvascular free flap surgery is often performed to address abnormalities in the bone or soft tissues surrounding the eyes and nose that can occur after skull base tumor removal surgery.
Other services, such as rehabilitation therapy and hearing and vision care may also be necessary.
Benefits of Skull Base Surgery
Patients who undergo skull base surgery at TGH will benefit from world-class care delivered in a state-of-the-art facility. More specifically, minimally invasive skull base neurosurgery performed by experts from the Neuroscience and Ear, Nose and Throat Institutes allows for:
- No bruising
- No brain retraction
- A shorter hospital stay
- Less risk for cognitive decline
- Reduced risk for cerebrospinal fluid leaks in the brain
- No external incisions and preservation of nasal and sinus function with endonasal approach
Become a Skull Base Surgery Patient
Learn more about TGH’s Skull Base Surgery Center, our neurosurgery and ENT skull base specialists and to find out if our approach to care if right for you. Call (855) 566-3627 to schedule an appointment.
