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Emerging Treatment Options for Skull Base Tumors and Related Diseases
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Emerging Treatment Options for Skull Base Tumors and Related Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 4906

Special Issue Editor

Dr. Matteo Zoli

E-Mail Website
Guest Editor
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40121 Bologna, Italy
Interests: skull base surgery; skull base tumors; pituitary tumors; endoscopic endonasal surgery; craniopharyngiomas; chordomas; meningiomas

Special Issue Information

Dear Colleagues,

Skull base tumors and related diseases refer to a group of conditions characterized by the growth of abnormal cells or tissues in the skull base region. These tumors can arise from various structures, including the bones, nerves, blood vessels, and connective tissues of the skull base. Skull base diseases represent a complex and challenging interdisciplinary field, where the modern approach to diagnosis, imaging and therapy involves an interdisciplinary team of neurosurgeons, otorhinolaryngologists, head and neck surgeons, neuroradiologists, and radiation therapy specialists. Currently, significant progress has been made in the diagnosis and treatment of skull base tumors and related diseases. However, the treatment of skull base tumors and related diseases remains challenging due to their location near complex and vital structures. Early diagnosis, personalized treatment, and long-term follow-up are crucial for the prognosis of patients.

This Special Issue welcomes submissions of relevant reviews, literature reviews, perspectives, and clinical research manuscripts.

Dr. Matteo Zoli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neurosurgery
  • skull base tumors
  • minimally invasive approaches
  • neuro-oncology
  • endoscopic endonasal surgery

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Published Papers (4 papers)

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11 pages, 675 KiB  
Article
Longitudinal Evaluation of Vestibular Symptoms in Patients with Vestibular Schwannoma After Robotic-Guided Stereotactic Radiosurgery Using the Dizziness Handicap Inventory (DHI)
by Daniel Rueß, Susanne Vojacek, Eda Güngör, Jan Christoffer Lüers, Stefan Hunsche, Karolina Jablonska, Martin Kocher and Maximilian I. Ruge
J. Clin. Med. 2025, 14(2), 299; https://doi.org/10.3390/jcm14020299 - 7 Jan 2025
Viewed by 664
Abstract
Background: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically [...] Read more.
Background: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically evaluate vestibular symptoms prior to and after SRS. Methods: For this retrospective single center study, we included patients who received Cyberknife® SRS for newly diagnosed unilateral VS between 2012 and 2022, and who had a minimum of two follow-up (FU) visits. Besides clinical assessment, the presence and severeness of vestibular symptoms before and after treatment was recorded by using the DHI. Overall DHI symptom scores (1–100) were classified into four grades (0 = “none”, 1 = “mild”, 2 = “moderate” and 3 = “severe”). The results were correlated with tumor-, patient-, and treatment-related characteristics. Results: We analyzed 128 patients with a median age of 60 years (range: 20–82) and a median FU of 36 months (range: 11–106 months). The median tumor volume was 0.99 cm3 (range: 0.04–7.1 cm3). A median marginal dose of 13 Gy (range: 12–14 Gy) was administered. The crude rate of local tumor control was 99.2%. The mean DHI total score at last follow-up (LFU, 25.5 ± 24.7; range 0–92) was significantly lower than before SRS (29.4 ± 25.3; range:0–92, p = 0.026), which was reflected in a higher proportion of patients with DHI grade “none” and a lower proportion of patients with DHI grade “severe” at LFU. Chi-square tests showed a significant correlation of the DHI grades (DHI 0–1 vs. DHI 2–3) with the absence or presence of vestibular symptoms both before SRS (p < 0.001, CI 95%) and at LFU (p = 0.038). Conclusions: The DHI is a feasible and valid instrument for measuring vestibular symptoms after SRS. In addition, the DHI enables the quantification of symptoms and can therefore serve as an important tool for outcome assessment after SRS of VS. In the present cohort, DHI scores improved significantly during FU. Full article
(This article belongs to the Special Issue Emerging Treatment Options for Skull Base Tumors and Related Diseases)
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17 pages, 635 KiB  
Article
Long-Term Quality of Life Among Patients Undergoing Endoscopic Pituitary Gland Surgery
by Narin Nard Carmel Neiderman, Shay Kaufman, Ran Bilaus, Anat Wengier, Tomer Ziv Baran and Avraham Abergel
J. Clin. Med. 2024, 13(21), 6371; https://doi.org/10.3390/jcm13216371 - 24 Oct 2024
Viewed by 889
Abstract
Introduction/Objectives: The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL [...] Read more.
Introduction/Objectives: The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL remain limited. To evaluate patients’ long-term nasal- and tumor-related QOL after endoscopic endonasal resection of pituitary tumors and to detect predictors for poor postoperative QOL. Study Design: This study was a prospective cohort study. Methods: All patients with pituitary adenomas who underwent trans-sphenoidal surgery at Tel Aviv Sourasky Medical Center between 2014 and 2021 were recruited. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery and 1, 2, and 3–5 years after surgery. Clinical data were collected and analyzed. Results: The study included 43 patients (18 women). No significant decrease was observed in tumor-related quality of life (QOL) scores, measured by ASBS-Q and SNOT-22, throughout the 5-year follow-up period. SNOT-22 score differences from the preoperative baseline at years 1, 3, and 5 were 0.81 [−4.84–6.58], 3.35 [−4.32–11.02], and 3.73 [−2.22–9.68], respectively, with no statistically significant changes. ASBS-Q scores similarly showed no significant changes over time. Subgroup analyses revealed that tumor characteristics (secreting vs. non-secreting, size), surgical factors (intraoperative cerebrospinal fluid leak, gross tumor resection, use of nasoseptal flap), and endocrine remission did not significantly impact QOL (p > 0.05 for all variables). Conclusions: Our study demonstrated that patients who underwent endoscopic pituitary lesion resection maintained high nasal- and tumor-related quality of life over a 5-year follow-up period. However, given the limitations of our study, further multi-center studies with larger patient populations are warranted to validate these results. Full article
(This article belongs to the Special Issue Emerging Treatment Options for Skull Base Tumors and Related Diseases)
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8 pages, 463 KiB  
Article
The Incidence of Radiologic Evidence of Sinusitis Following Endoscopic Pituitary Surgery: A Multi-Center Study
by Dan Yaniv, Stephanie Flukes, Nir Livneh, Igor Vainer, Ethan Soudry, Nimrod Amitai, Daniel Spielman, Marc A. Cohen and Aviram Mizrachi
J. Clin. Med. 2024, 13(17), 5143; https://doi.org/10.3390/jcm13175143 - 30 Aug 2024
Viewed by 1140
Abstract
Background: Endoscopic endonasal skull base surgery has become a viable alternative to open procedures for the surgical treatment of benign and malignant lesions in the sinonasal and skull base regions. As in sinus surgery, skull base surgery may cause crusting and posterior [...] Read more.
Background: Endoscopic endonasal skull base surgery has become a viable alternative to open procedures for the surgical treatment of benign and malignant lesions in the sinonasal and skull base regions. As in sinus surgery, skull base surgery may cause crusting and posterior rhinorrhea, particularly when a nasoseptal flap is required for skull base reconstruction. Post-operative radiological sinonasal findings have been reported previously with no clear correlation with intraoperative decision-making. As in open surgery, endoscopic surgery is not standardized and there is variability in the intervention to assist with exposure and skull base repair. These modifications, including middle turbinate resection, nasoseptal flap, fat graft, and maxillary antrostomy have the potential for nasal morbidity. The aim of this study was to evaluate whether specific interventions during surgery or specific patient and tumor characteristics harbor a more significant risk of causing nasal morbidity post-operatively, as demonstrated by post-operative imaging. Methods: A retrospective analysis of all patients who underwent endoscopic endonasal skull base surgery for pituitary lesions at two major referral centers was performed. Data on demographic, clinical, and pathological features were collected, and pre- and post-operative imaging studies (computed tomography (CT) and magnetic resonance imaging (MRI)) were reviewed and scored according to the Lund–Mackay (LM) scoring system. Results: The study included 183 patients. Radiographic evidence of sinusitis was observed in 30 patients (LM score > 4) in post-operative imaging studies. Patients who underwent middle turbinectomy or nasoseptal flap were found to have significantly higher LM scores on follow-up imaging. A nasoseptal flap was found to be associated with an average increase in LM score of 1.67 points and middle turbinectomy with an average increase of 2.21 points. There was no correlation between tumor size and findings that were compatible with sinusitis on post-operative imaging. Conclusions: The findings of the present study suggest that endoscopic endonasal skull base surgery is associated with radiological evidence of sinusitis. Nasoseptal flap reconstruction and middle turbinectomy were strongly associated with radiographic sinusitis and should be judiciously performed during surgery. A clinical correlation is needed for further recommendations. Full article
(This article belongs to the Special Issue Emerging Treatment Options for Skull Base Tumors and Related Diseases)
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14 pages, 5378 KiB  
Systematic Review
Clival Metastases: Single-Center Retrospective Case Series and Literature Review
by Alessandro Carretta, Giacomo Sollini, Federica Guaraldi, Arianna Rustici, Marcello Magnani, Sofia Asioli, Marco Faustini-Fustini, Ernesto Pasquini, Matteo Zoli and Diego Mazzatenta
J. Clin. Med. 2024, 13(9), 2580; https://doi.org/10.3390/jcm13092580 - 27 Apr 2024
Cited by 2 | Viewed by 1418
Abstract
Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience [...] Read more.
Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk–benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers. Full article
(This article belongs to the Special Issue Emerging Treatment Options for Skull Base Tumors and Related Diseases)
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