Skull Base Surgery in Sydney

Endoscopic skull base surgery is a minimally invasive approach that uses nasal endoscopes to access and treat tumours, cerebrospinal fluid leaks and complex pathology at the base of the skull. Performed through the nose without external incisions, this technique avoids traditional craniotomy and offers faster recovery, less pain and excellent tumour visualisation.

What Is the Skull Base?

The skull base is the bony floor of the cranial cavity that separates the brain from the structures of the face, nose and sinuses. It is a complex area containing critical nerves, blood vessels and the pituitary gland. Pathology in this region, tumours, leaks, infections, historically required open surgery through the skull or face. Endoscopic techniques now allow many of these conditions to be treated through the natural corridor of the nose.

Conditions Treated

Pituitary Tumours

Pituitary adenomas are benign growths of the pituitary gland, a small structure located behind the nose at the centre of the skull base. Depending on their size and type, they can cause hormonal imbalances (such as excess growth hormone, prolactin or cortisol), visual disturbance from compression of the optic nerves, and headache.

Endoscopic transsphenoidal surgery is the standard approach for removing pituitary tumours. The ENT surgeon creates a passage through the sphenoid sinus to expose the pituitary fossa, and the neurosurgeon removes the tumour under direct endoscopic visualisation. This combined approach achieves high rates of complete tumour removal while preserving normal pituitary function.

Cerebrospinal Fluid (CSF) Leaks

A CSF leak occurs when there is a defect in the skull base allowing cerebrospinal fluid to drain into the nasal cavity. Patients typically notice clear, watery fluid running from one nostril, often worsened by bending forward. CSF leaks carry a risk of meningitis and require surgical repair.

Endoscopic repair involves identifying the precise site of the defect using CT and MRI imaging, then sealing it with a multilayer reconstruction using tissue grafts such as nasal mucosal flaps, fascia and sometimes synthetic materials. Success rates for endoscopic CSF leak repair exceed 90 per cent in experienced hands.

Complex Sinonasal Pathology

Skull base techniques are also applied to complex conditions of the sinuses and nasal cavity, including:

• Inverted papilloma: a locally aggressive benign tumour that arises from the sinus lining and requires complete excision to prevent recurrence
• Sinonasal malignancy: cancers of the nasal cavity and paranasal sinuses, which in selected cases can be resected endoscopically
• Mucocele: expanding mucus-filled cysts in the frontal or sphenoid sinuses that erode into the skull base
• Juvenile nasopharyngeal angiofibroma: a vascular tumour of the nasopharynx seen in adolescent males

Our Skull Base Team

At Central Sydney ENT, skull base surgery is performed by fellowship-trained rhinologists with subspecialty expertise in endoscopic skull base approaches, working in collaboration with neurosurgical colleagues at major Sydney teaching hospitals. Relevant surgeons include:

• Dr Rahuram Sivasubramaniam
• Dr Alexander Zhang
• Dr Arjuna Ananda

Related Conditions

• Pituitary Tumours: benign growths of the pituitary gland causing hormonal and visual symptoms
• CSF Leak: cerebrospinal fluid drainage through a skull base defect
• Nasal Polyps: benign growths in the sinus lining that may extend to the skull base
• Head and Neck Cancer: including sinonasal malignancies