Skull base tumours 

The skull base consists of several bones that form the bottom of the skull underneath the brain and the bony ridge behind the eyes and nose.

Many different kinds of tumours grow in this area and are often not diagnosed until they grow large enough to put pressure on the brain or nerves to the eyes. They can grow deep within the skull and close to critical nerves and blood vessels in the brain, head, neck and spinal cord.

Skull base tumours can originate in the skull base (a primary tumour) or spread there from a cancer elsewhere in the body (metastatic disease).

The majority of tumours which are in the skull base area are benign (non-cancerous) however there are very rare types of tumour which are malignant (cancer).

Tumours in the base of the skull can cause problems with coordination, balance, and speech and swallowing. This might affect dextrous movements in the arms and hands, leg movements during walking, and unsteadiness when sitting or standing. The nerves that supply the face are also located in this area and could be affected.

These difficulties can have an impact on how you move, or how independently you can do daily activities.

If you experience difficulties in any of these areas during your treatment journey you may be seen by one, or more, of our specialist therapy services.

  • Vestibular schwannoma (acoustic neuroma)

    Skull base tumours are a rare type of tumour. The most common tumour which grows within the skull base is called a vestibular schwannoma. 1 new vestibular schwannoma diagnosed every year for each of every 80,000 of the population.

    A vestibular schwannoma is a benign (non-cancer) tumour which starts in the Schwann cells (fatty cells) on the outside of the vestibular nerve.

    The vestibular nerve controls balance – together with the cochlear nerve they run from the brain stem to the inner ear where the organs of balance and hearing are. Despite the fact that the tumours arise from the vestibular nerve, they present most commonly with unilateral hearing loss (hearing loss on both sides) and tinnitus because of the proximity to the cochlear (auditory) nerve.

    These tumours are typically very slow growing, benign and do no spread outside the brain. Vestibular schwannomas have often been there for a long time before they are diagnosed. They are usually diagnosed in people aged 50-60.

    The most common symptom of having a vestibular schwannoma is unilateral hearing loss and many patients experience imbalance.

    Rarely these tumours grow due to a result of a genetic condition called neurofibromatosis type 2 (NF2). People with NF2 are usually diagnosed at a young age and tumours may grow on both sides of the brain.

    Many of these tumours do not require any treatment and are monitored by annual MRI scans. Depending on the size of the tumour and whether the tumour is growing there are treatments available such as a specialist type of radiotherapy called the Gamma Knife and surgery however these treatments will not bring back the hearing which has already been lost.

 Consultants

Dr Naomi Fersht, Consultant Clinical Oncologist

Dr Naomi Fersht

Dr Naomi Fersht coordinates care across brain tumour services at UCLH.

She is a consultant clinical oncologist at University College Hospital and the National Hospital for Neurology and Neurosurgery (NHNN). She specialises exclusively in the management of primary and secondary brain and spinal tumours. This involves the use of both conventional and innovative radiotherapy techniques and chemotherapy. 

Her special interests are: brain oligometastases; meningiomas; pituitary tumours; the management of teenagers and young adults with brain tumours (age 16-24); and advanced radiotherapy techniques including radiosurgery.

She qualified from the University of Cambridge and her specialist training was at the Royal Marsden and University College Hospitals. Naomi's doctoral thesis, supervised by Nobel Laureate Sir Paul Nurse, was in cell cycle checkpoints.

Full consultant profile

Mr Peter Andrews, Consultant Anterior ENT Surgeon

Mr Peter Andrews

Mr Peter Andrews, Consultant ENT and Head and Neck Surgeon, was appointed to the Royal National Throat Nose and Ear Hospital in 2005. He has a sub speciality interest in Rhinology and Facial Plastic Reconstructive Surgery.

His main clinical areas of interest include nasal airway reconstruction and facial reanimation surgery. He has co-designed and implemented a tertiary referral facial function clinic at the RNTNEH.

He has an expanding interest in sinonasal neoplasia and other aspects of anterior skull base surgery. He is an Honorary Consultant Surgeon at the National Hospital for Neurology and Neurosurgery (NHNN) and is an active member of its monthly skull base MDT.

Full consultant profile

Mr Robert Bradford, Consultant Neurosurgeon

Mr Robert Bradford

Mr Bradford qualified in 1979 at University College Hospital Medical School followed by house jobs at Addenbrooke's and UCLH. He obtain his FRCS in 1983 following general surgical training. He spent two years conducting research in neuro-oncology at The Institute of Neurology which lead to the award of Doctor of Medicine (MD) in 1987.

He undertook clinical neurosurgical training at The National Hospital for Neurology and Neurosurgery (NHNN) and The Wessex Neurological Centre. He was appointed consultant neurosurgeon at the Royal Free Hospital in 1989 and also honorary consultant neurosurgeon at The Royal National Orthopaedic Hospital, Stanmore.

He is a past Chair Brain/CNS tumour board North London Cancer Network.

As well as an interest in neuro-oncology he has an extensive skull base practice.

Full consultant profile

Prof Sebastian Brandner, Consultant Neuropathologist

Prof Sebastian Brandner

Sebastian Brandner is Professor of Neuropathology at UCL and Honorary Consultant Neuropathologist at the National Hospital for Neurology and Neurosurgery (NHNN) at UCLH. He leads the Division of Neuropathology and is specialised in brain tumour diagnostics including molecular diagnostics, and neurodegeneration.

He has authored and co-authored research publications on brain tumour models, book chapters in major neuropathology textbooks, and the 2016 WHO classification as well as guidelines for the Royal College of Pathologists. He serves on the National Institute of clinical excellence (NICE) guideline committee to establish guidelines for management and treatment of primary brain tumours and cerebral metastases

The Division of Neuropathology receives brain tumour referrals from the NHNN, and several major regional hospitals. The Division also provides a molecular pathology service for referrers across the United Kingdom.

Full consultant profile

Mr David Choi, Consultant Neurosurgeon

Mr David Choi

Mr David Choi trained in general surgery at the Glasgow Royal Infirmary, and underwent specialist neurosurgical training at the Glasgow Institute of Neurological Sciences, Atkinson Morley’s Hospital and the National Hospital for Neurology and Neurosurgery (NHNN), London. He obtained a PhD in neuroregeneration, and was awarded the Hallett Prize medal from the Royal College of Surgeons, London.

His clinical interests include complex spine surgery, spinal tumours, spinal trauma, degenerative spinal conditions, skull base tumours, skull base endoscopy, and craniocervical junction surgery. He holds an academic post at the UCL  Institute of Neurology, and was awarded a prestigious research grant from the European Research Council in 2009.

Full consultant profile

Mr Sherif Khalil, Consultant Lateral ENT Surgeon

Mr Sherif Khalil

Mr Sherif Khalil completed his higher surgical training in the North Thames region in London in all aspects of elective and emergency otolaryngology. He has trained in different centres of excellence such as Charing Cross, The Royal National Throat, Nose and Ear, The National Hospital for Neurology and Neurotology (NHNN) and the Northwick Park Hospitals.

He has experience in all aspects of surgery of the ear, nose and throat and is a lateral skull base surgeon at the NHNN.

Full consultant profile

Mr Neil Kitchen, Consultant Neurosurgeon

Mr Neil Kitchen

Mr Neil Kitchen is a consultant neurosurgeon at the National Hospital for Neurology and Neurosurgery (NHNN) and lead neurosurgeon for neuro-oncology.

He studied medicine at Bart's Health, University College London Hospitals and at Addenbrooke's Hospital in Cambridge. Before moving to Cambridge he completed a BSc degree in the history of medicine at the Wellcome Institute.

Mr Kitchen has special clinical interest in brain tumour surgery, intracranial microsurgery, trigeminal neuralgia, cavernoma and radiosurgery (Gamma Knife).

Mr Kitchen has also worked at Bart's, Charing Cross Hospital, the Royal Free, Atkinson Morley's, Southend Hospital, and the National Hospital for Neurology and Neurosurgery.

Full consultant profile

Mr Rupert Obholzer, Consultant Lateral ENT Surgeon

Mr Rupert Obholzer

Mr Rupert Obholzer is an ENT consultant specialising in disorders and surgery of the ear, skull base, facial nerve and parotid gland.

Full consultant profile

Prof Shakeel Saeed, Consultant Lateral ENT Surgeon

Prof Shakeel Saeed

Professor Saeed graduated from King’s College, London and has been a consultant ENT and skullbase surgeon in Manchester Royal Infirmary and Hope Hospital until his present Professorial appointment in London. He also holds honorary appointments at University College Hospital, King’s College Hospital, Guy’s Hospital as well as St George’s Hospital in London.

He has extensive experience in lateral skullbase surgery as well as implantation otology and has published prolifically on these topics. He undertakes peer review as well as serves on the editorial board for numerous international journals. He is enthusiastically active in otological research and currently holds £1.5 Million in research grants.

Full consultant profile

 Clinical Nurse Specialists (CNS)

Orla McKee, Clinical Nurse Specialist (CNS)

Orla McKee

Orla qualified as a registered nurse in 1993 and has worked in many specialist areas of neurosciences since 1993. She has experience as a ward sister for 7 years looking after a variety of patients with brain and spinal issues. She has specialised as a clinical nurse specialist in both benign and malignant brain tumours since 2008.

"I enjoy working within a multidisciplinary team who focus on the complex needs of this group of patients."

Nichola Brown, Clinical Nurse Specialist (CNS)

Nichola Brown

Nichola is one of the few skull base clinical nurse specialists in the country. She is heavily involved with the skull base service at the National Hospital for Neurology and Neurosurgery, Queen Square, and act as a point of contact providing specialist information for patients with skull base tumours.

Nichola’s background is in neuro-intensive care which has provided her with invaluable neuroscience knowledge and skills. Her role includes endeavouring to meet all patients with a suspected brain tumour who are admitted for surgery at Queens Square.

“I provide support for these patients and their families through what can be a very difficult and uncertain time.”