Cranial Base Surgery (also referred to as skull base surgery) is a very small but sophisticated specialty dedicated to the treatment of tumors that originate along the undersurface of the brain. These tumors can begin in the brain itself, along nerves and tissues that attach to the undersurface of the brain, or within the eye sockets and paranasal sinuses that are next to the brain and cranial base. The cranial base itself is best described as those areas of the skull upon which the brain rests, i.e. the eye sockets, the paranasal sinuses, the temporal bone (where the hearing organ of the ear is located), and the bone around the area where the spinal cord joins the brain. Both benign and malignant tumors affect all of these areas. In general, the vast majority of the malignant tumors that affect the cranial base begin in the nasal cavity or paranasal sinuses, though they can also originate in the other areas. Benign tumors, such as acoustic neuromas and meningiomas, tend to begin within the brain or the temporal bone.

A hallmark of contemporary cranial base surgery is the utilization of a team of surgeons from allied health care specialties such as Otolaryngology-Head & Neck Surgery (Ear, Nose and Throat), Neurosurgery, and potentially plastic surgery. The neurosurgeon is responsible for dealing with the brain and any complications that arise from operating around those complex structures. The Otolaryngologist-Head & Neck Surgeon is important in providing access to the cranial base, and in removing cancers that originate in the nose and paranasal sinuses. The Otolaryngologist-Head & Neck Surgeon also tends to coordinate the involvement of other critically important specialists who deliver chemotherapy or radiation therapy, either before or after surgery. A plastic surgeon is frequently valuable in insuring that facial appearance and function remain as close to normal after surgery, given that many cranial base procedures require surgery through the face. Some Otolaryngologists who perform skull base surgery are also trained Facial Plastic Surgeons, thereby providing a more comprehensive combined expertise.

In addition to the core team of surgeons, support personnel in the form of neuroanesthesiolgists, radiation oncologists, medical oncologists, ICU intensivists, interventional neuroradiologists, etc. are also required for success. As a result, we have decided not to list individual doctors, but instead include the names of surgeons who lead surgical teams dedicated to the comprehensive treatment of cranial base malignancies. We have eliminated surgeons from this list who primarily treat benign skull base tumors such as acoustic neuromas or mengiomas. Though these doctors may be exceptional surgeons with peerless reputations, they did not meet our team criteria for the treatment of cranial base malignancies. We have also omitted the names of surgeons, regardless of individual reputation, who are not known to have a long-standing team of specialists dedicated to the treatment of cranial base malignancies.

Given that a significant number of cranial base tumors have traditionally been regarded as incurable or inoperable, it is critical that patients with such tumors seek out a team of doctors with specific expertise in this field. Over the past decade the advances in the treatment of cranial base tumors has been dramatic, but such expertise is not routinely available in all areas of the country, and local medical doctors frequently are not aware of these specialized teams. Obtaining prompt treatment from an experienced team can mean the difference between curing a tumor, or simply delaying its eventual return without the chance for cure. Further, patients treated by methods that are not up-to-date have a greater chance of facial deformity or a loss of function relating to speech, swallowing, and vision.

C. Phillip Daspit MD
Dept. Of Neurosurgery
Barrow Neurosurgical Associates
2910 N. 3rd
Phoenix, AZ 85013
Tel: 602-406-3489
Fax: 602-406-4195
E-mail: robert.speltzer@bnanero.net

Specialty Training and Certification:
Otology-Neurotology, Otolaryngology - HNS

Cranial Center Contact:
212-523-6756

Mark Bilsky, MD
Department of Neurosurgery
1275 York Avenue, C705
New York, New York 10021
Tel: 212-639-8526
Fax: 212-717-3231
E-mail: bilskym@mskcc.org
Specialty: Neurosurgery

Jatin P. Shah, MD
1275 York Avenue
New York, New York 10021
Tel: 212-639-7233
Fax: 212-717-3302
E-mail: shahj@mskcc.org

Specialty Training and Certification:
General Surgery, Head & Neck Surgical Oncology

Dennis H. Kraus, MD
Department of Otolaryngology
1275 York Avenue, Box 285
New York, New York 10021
Tel: 212-639-5621
Fax: 212-717-3302
E-mail: krausd@mskcc.org

Specialty Training and Certification:
Otolaryngology - HNS, Head & Neck Surgical Oncology

Johnny B. Delashaw, Jr. MD
Dept. of Neurosurgery
3181 SW Sam Jackson Park Road
Suite L-472
Portland, OR 97201
Tel: 503-494-7737
Fax: 503-494-7161
E-mail: delashaw@ohsu.edu

Specialty Training and Certification:
Neurosurgery, Cranial Base Surgery

Mark K. Wax, MD
Dept. of Otolaryngology
3181 SW Sam Jackson Park Rd.
Suite PV-01
Portland, OR 97201
Tel: 503-494-5355
Fax: 503-494-4631
E-mail: waxm@ohsu.edu

Specialty Training and Certification:
Otolaryngology-HNS, Facial Plastic and Reconstructive Surgery

Ricardo Carrau, MD
Dept. of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
Tel: 412-647-8186
Fax: 412-647-2080
E-mail: carraurl@msx.upmc.edu

Specialty Training and Certification:
Otolaryngology - HNS, Head & Neck Surgical Oncology, Cranial Base Surgery

Carl H. Snyderman, MD
Dept. of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
Tel: 412-647-8186
Fax: 412-647-2080
E-mail: csnyd@pitt.edu

Specialty Training and Certification:
Otolaryngology - HNS, Cranial Base Surgery