The base of the skull is the base on which the brain rests. It is a very complex anatomical region located deep in the face, under the brain and in front of the brainstem. It is the most complex anatomical region of the body

The multiple bony structures that compose it are crossed by:

the vessels that irrigate the brain
Spinal cord
the nerves that control:
The sense organs (sight, smell, hearing, taste)
oculomotor muscles
facial muscles (mimicry, chewing)
organs of swallowing
the sensitivity of the face
Type of lesions

Surgery at the base of the skull treats lesions located deep between the base of the skull and the brain or in the base of the skull. The most common pathologies affecting the base of the skull are tumors. These tumors of the skull base may be histologically “benign” (eg, meningiomas, acoustic neuromas, pituitary adenomas, craniopharyngiomas) or cancers (eg, sinus, bone, cartilage, ear or salivary glands).


Symptoms and diagnosis

Early diagnosis and multidisciplinary management is the key to treating and curing many of these tumors.

Because of the location of these tumors, skull base lesions can cause a variety of symptoms such as sight, hearing, smell, balance, swallowing, headaches, asymmetry of the face, sensory disturbances and / or facial pains, obstruction of the nose, vertigo …

Examinations that identify the lesion are CT and brain MRI. Other examinations may be requested depending on the type of lesion suspected and its location. :

An ophthalomological assessment
ENT assessment to assess hearing and balance or swallowing
An endocrinological assessment
Strategies and surgical techniques

This complex surgery involves breaking through the base of the skull to access and expose the lesion to be removed while avoiding any separation (pressure) of the brain. It is a question of choosing the path of access to the lesion most adapted to the position of the tumor and the patient.

Excision of the lesions poses significant challenges because of their proximity to important vital neurovascular structures. The removal of these lesions, which are among the most complex pathologies to operate, is sometimes associated with significant surgical risk.

Our service is specialized in the surgery of the base of the skull and masters all the approaches, techniques and technologies necessary for the practice of this surgery. This knowledge and mastery of the technical tools necessary to the practice of this surgery, is the essential condition to the reduction and the maximum control of the risks:

Endoscopic Endoscopic Endoscopic Pathways
The endoscopic endoscopic approach (EEE) is an innovative surgical technique used to treat brain tumors, lesions of the skull base and the junction between the skull and the spine, through the nose and natural nasal cavities. using an adapted endoscope and instrument.

A specially designed endoscope provides a light and a lens for viewing and transmitting internal images. Specific instruments are used along the endoscope to expose and remove the tumor.

The endoscopic endoscopic approach allows surgeons to treat many hard-to-reach tumors, even those previously considered “unaffordable”, without crossing the face or skull.

The neurosurgery department of Lariboisière was one of the pioneering services in the world in the development of these techniques.

Transpetous ways
They consist of making their way through the bony mass which is located on the side of the skull around the ear and which includes the organ of hearing and balance as well as many nerves and vessels. They make it possible to approach the lesion at a more adapted attack angle and minimize the distance between the brain which is very poorly tolerated and sometimes causes significant sequelae. These pathways to injury involve high-speed motors and diamond burs, which allow skeletalization of nerve structures, sense organs, and vessels passing through the bone. These surgeries are sometimes performed in two stages because of their sometimes very long duration.

Orbital and orbito-zygomatic removal around the orbit
These techniques consist of walking along the orbit and the eyeball to access deeply located lesions.