Skull Base and Pituitary Surgery in Singapore: A Comprehensive Clinical Guide

These are located at the front of the skull base, near the eye sockets and the roof of the nasal cavity.

• Meningiomas: Tumours arising from the protective membranes of the brain.
• Esthesioneuroblastomas: Rare tumours starting in the olfactory (smell) nerves.
• Sinonasal Cancers: Conditions that may invade the skull base from the nasal passages.

This region is dominated by the pituitary gland.

• Pituitary Adenomas: The most common tumours in this area. They may be “functioning” (producing excess hormones) or “non-functioning.”
• Craniopharyngiomas: Benign but complex tumours that grow near the pituitary stalk.
• Chordomas: Rare, slow-growing bone tumours arising from remnants of the embryonic notochord.

These are found at the back of the skull, near the brainstem and cerebellum.

• Acoustic Neuromas (Vestibular Schwannomas): Tumours on the nerve responsible for hearing and balance.
• Glomus Tumours: Highly vascular growths near the base of the skull and neck.

This is a minimally invasive technique that has changed the management of many skull base conditions.

• The Process: The surgeon uses high-definition endoscopes (thin tubes with cameras) inserted through the nostrils. No external incisions are made.
• The Benefit: It provides a direct line of sight to the pituitary gland and central skull base. This approach may result in less post-operative pain and a shorter hospital stay for suitable candidates.

This is a long-standing technique often used for pituitary tumours. The surgeon works through a small incision under the upper lip or inside the nose using an operating microscope for three-dimensional visualisation.

For larger tumours or those located at the side or back of the skull, a craniotomy may be required.

• Technique: A section of the skull bone is temporarily removed. Specialised “skull base approaches” are used to reach the bottom of the brain while minimising the need to move (retract) healthy brain tissue.
• Utility: This approach is often used for tumours like acoustic neuromas or large meningiomas.

In some cases, physical surgery is combined with targeted radiation (such as Gamma Knife). This can be used to treat any small “remnants” of a tumour that were too risky to remove during surgery.

Hospital stays for skull base surgery usually range from 3 to 7 days. During this time, the focus is on pain management and ensuring no cerebrospinal fluid (CSF) is leaking from the nose or the incision site.

Patients are advised to take it slow.

• Activity: Most patients can walk around and do light housework but must avoid heavy lifting or straining, which can increase pressure inside the head.
• Medications: Steroids may be used to reduce brain swelling, and hormone replacements may be necessary if the pituitary gland was affected.
• Follow-up: The first post-operative scan is usually scheduled within a few weeks to assess the extent of the tumour removal.

Complete healing of the skull base can take several months. Ongoing care with an endocrinologist is often necessary for pituitary patients. For those with posterior skull base surgery, balance rehabilitation or physical therapy may be helpful in regaining full mobility.