Guide to treatment for skull base tumours

Written by: Dr Shanmugasundaram Ramkumar
Published: | Updated: 09/08/2021
Edited by: Karolyn Judge

Most skull base tumours are benign but some can be cancerous and require rapid action. Even if they aren't life threatening and are causing symptoms, they need treatment. But what's involved? Leading consultant clinical oncologist Dr Shanmugasundaram Ramkumar has put together an expert guide.


Young girl just about to have a brain scan, supervised by nurse


After a diagnosis of skull base tumour, how quickly should treatment start?

The treatment for skull base tumours depends on the type of tumour, generally both benign and malignant tumours can occur in the skull base. Benign tumour like meningiomas, acoustic neuromas, nerve sheath tumours are slow growing and there is no immediate need to start treatment unless they become symptomatic and/or there is rapid tumour progression. Aggressive skull base tumours like chordomas/chondrosarcomas need treatment sooner.



What treatments are there for skull base tumours?

Surgery and radiotherapy are the main treatment modality for skull base tumours or a combined modality approach with surgery followed by adjuvant radiotherapy, can be considered.



What factors do you take into account when creating a treatment plan?


  • tumour histology
  • location of tumour
  • age of patient
  • performance status of patient
  • rapidness of tumour progression
  • radiotherapy tolerance of surrounding organs at risk such as:


  1. 1. Brainstem.
  2. 2. Spinal cord.
  3. 3. Optic nerves.
  4. 4. Cochlea
  5. 5. Retina.
  6. 6. Cranial nerve.
  7. 7. Brain tissue.
  8. 8. Hippocampus.


What is the survival rate of patients with a skull base tumour?

The survival rate of skull base tumours depends on the histology of the tumour and whether they are benign/aggressive. Generally, benign tumours are more common in skull base region and the survival is very good for such benign tumours like meningiomas. Chordomas are more aggressive and malignant tumours and five-year survival is around 70 per cent. Chondrosarcoma which occurs in the skull base have a better five-year survival rate of 85 per cent.



When is palliative care the best option?

Skull base tumours are best managed with surgery, radiotherapy or a combined surgery-radiotherapy approach, but if the skull base tumours are extensive/advanced with severe symptoms in an elderly patient with poor performance status, then palliative care would be the most appropriate management.



What is the life expectancy of patients after treatment?

Life expectancy depends on the histology and aggressiveness of skull base tumours. Most benign tumours have a good prognosis and longer life expectancy, but aggressive tumours like chordoma/secondaries tend to have a shorter life expectancy.



How often should patients have check-ups after recovery?

Benign tumours are followed up clinically at six monthly intervals in the first year after their treatment and thereafter with annual scans. Aggressive skull base tumours are followed up at four to six monthly intervals. The follow up check-ups include clinical examination and yearly MRI scans.



If you’re looking for expert assistance for a skull base tumour, Dr Ramkumar can provide leading care. Get in touch by visiting his Top Doctors profile here.


By Dr Shanmugasundaram Ramkumar
Clinical oncology

Dr Shanmugasundaram Ramkumar is a leading consultant clinical oncologist in Reading and Southampton who specialises in the non-surgical treatment of head and neck cancer, skull base tumours and gastrointestinal tumours. He is highly experienced in providing treatment using radiotherapy (Intensity Modulated Radiotherapy, Proton Beam Therapy, Stereotactic radiotherapy, Intraoperative radiotherapy), immunotherapy and chemotherapy.

Dr Ramkumar has 8 years experience in treating cancer patients with Proton Beam Therapy and more than 25 years experience in non-surgical management (Radiotherapy, chemotherapy & systemic therapy) in Oncology. Dr Ramkumar has completed several prestigious International Training Fellowships in Proton Beam Therapy and Intraoperative radiotherapy in USA and Europe.

Dr Ramkumar completed his oncology training in India in 1997 and furthered his clinical oncology training on the Wessex Clinical Oncology Training Scheme in 2009. He has since held several senior leadership roles in postgraduate training, technical leadership roles and management roles.

He is a specialist advisor for the Quality Care Commission, Clinical Expert for Technological Appraisals for National Institute for Health and Care Excellence(NICE), Radiotherapy Clinical Reference Group Member for NHS England, expert reviewer for the National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), External Professional Advisor for Clinical Advice Directorate in the Parliamentary and Health Service Ombudsman, UK, reviewer for Journal of Clinical Oncology, senate member of Clinical Reference Group (CRG) for Complex Head & Neck cancer and a National Cancer peer review panel member (Quality Surveillance Team).

Dr Ramkumar is a principal investigator for several national and international clinical trials in head and neck cancers. He is a project consultant for low-level laser therapy (LLLT) studies at the University of Hong Kong. He pioneered the implementation of LLLT for treating cancer treatment-related toxicities and Intraoperative Electron Radiotherapy (IOERT) for cancer treatment in the UK.

Dr Ramkumar is a senior medical advisor and the Lead Clinician for proton therapy for the Rutherford Cancer Centres.

Here you can view Dr Ramkumar's reviews on IWantGreatCare.

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