Cedars-Sinai Earns National Recognition for Skull Base Tumor Care

Cedars-Sinai has been named a Multidisciplinary Team of Distinction by the North American Skull Base Society, a national recognition awarded to programs that bring together specialists across disciplines to advance care for patients with complex skull base tumors through clinical expertise, research, education and innovation. These programs offer advanced surgical approaches to treating skull base tumors, including some cases considered inoperable elsewhere.

The designation recognizes Cedars-Sinai's collaborative approach to treating tumors that develop at the base of the skull-an anatomically complex area where tumors grow near nerves and blood vessels that control vision, hearing, facial movement and swallowing.

"There is very precious real estate, and treatment often requires expertise from multiple specialties," said Vladimir Ljubimov, MD, assistant professor of Neurosurgery at Cedars-Sinai, where he and other neurosurgeons at Cedars-Sinai Medical Center and Torrance Memorial Medical Center collaborate with a range of specialists to remove some of the most complex tumors.

The Cedars-Sinai Newsroom spoke with Ljubimov about what skull base surgery involves, why a multidisciplinary team is essential, and how advances in surgical techniques are expanding treatment options for patients.

What is skull base surgery?

Skull base surgery involves treating tumors that develop in one of the body's most anatomically complex regions. But the goal isn't simply to remove the tumor-it's to do so while preserving the nerves and blood vessels that control critical functions. Even a small injury to one of these structures can have life-altering consequences, including stroke, vision loss or facial paralysis. That's why skull base surgery requires advanced techniques, meticulous planning and close collaboration among specialists.

Treatment is tailored to each patient. Depending on the tumor's location, we may perform a traditional craniotomy, in which surgeons temporarily remove a small section of the skull to reach the tumor. We also use minimally invasive endoscopic techniques through the nose, orbit, or mouth, or combine multiple surgical approaches. These techniques allow us to safely treat tumors that were once considered extremely difficult or even impossible to reach.

What does a multidisciplinary skull base team involve?

Skull base surgery is truly a team effort. Neurosurgeons and otolaryngologists often work together during surgery, especially for minimally invasive endoscopic procedures performed through the nose or ear. Depending on where the tumor is located, other specialists may join the team. For example, ophthalmologists and oculoplastic surgeons help us safely treat tumors near the eye while preserving vision and appearance. Plastic surgeons may assist with reconstruction when needed. We also collaborate with endocrinologists, neuro-oncologists, neurologists and radiation oncologists, depending on the patient's diagnosis.

Every case is reviewed by our multidisciplinary team before surgery. Together, we evaluate imaging, discuss treatment options and determine the safest, most effective approach. Just as important as removing the tumor is reconstructing the skull base afterward. Our specialists work together to rebuild these structures, helping prevent complications such as cerebrospinal fluid leaks or infection while allowing patients to recover safely. After surgery, we continue coordinating care, which may include hormone management, radiation therapy, chemotherapy or rehabilitation.

What are the symptoms of a skull base tumor?

Not all skull base tumors are cancerous. Many are benign, but because of where they're located, they can still cause serious problems by pressing on the brain, nerves or blood vessels.

Skull base tumors include tumors such as pituitary tumors, tumors that arise from the lining of the brain (meningiomas), rare tumors that develop near the pituitary gland (craniopharyngiomas), tumors of the bone and cartilage (chordoma, chondrosarcoma), as well as cancers that have spread to the skull base from other parts of the body.

Symptoms vary depending on where the tumor is located and may include vision changes or vision loss, double vision, dizziness, balance problems, headaches, nausea or hormonal changes.

What are the latest advances in skull base surgery?

One of the biggest advances is the development of sophisticated endoscopic techniques that allow us to reach tumors through the natural openings of the nose, avoiding large incisions in many cases. These approaches give us access to areas that were once considered too risky to operate on, including tumors deep within the skull base and around the cavernous sinus.

As technology continues to advance, we're able to treat increasingly complex tumors with greater precision while reducing complications and improving quality of life for our patients.

How should patients look for the right skull base surgeon for them?

Patients should look for a program that offers multidisciplinary care. Complex skull base conditions often require expertise from multiple specialists, and having those experts work together from the beginning leads to more comprehensive treatment planning.

At Cedars-Sinai, we evaluate each case as a team and offer the full spectrum of surgical and nonsurgical treatment options. If a patient has been told their tumor is too difficult to remove or has limited treatment options, seeking a second opinion at a high-volume skull base center can help determine whether additional approaches may be available.

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