My-ENT

Condition

Skull Base Conditions

Clinical term: Anterior Skull Base Pathology

The skull base is the floor of the skull, forming the boundary between the brain and the nasal cavity, sinuses, and face. Conditions affecting the anterior skull base include benign growths, pituitary lesions, encephaloceles (herniation of brain tissue into the nasal cavity), and other pathologies. Many of these can now be assessed and treated through endoscopic approaches from within the nose, without the need for open surgery or external incisions.

Symptoms

What patients often notice

  • Persistent one-sided nasal blockage that does not respond to standard treatment.
  • Reduced or absent sense of smell, particularly when sudden in onset or one-sided.
  • Clear, watery nasal discharge — this may indicate cerebrospinal fluid (CSF) leaking from around the brain and warrants prompt assessment.
  • Visual changes or double vision in association with nasal or sinus symptoms.
  • Headache or facial pressure that is unusual in character or not typical of sinusitis.
  • A nasal lesion or mass identified on imaging.
  • Spontaneous nosebleeds without an obvious cause.

Causes

Why this can happen

Most skull base conditions do not have an identifiable external cause - they arise from the tissues of the skull base itself.

Slow-growing benign tumours, such as pituitary adenomas or meningiomas, arising from cells normally present in the region.

Congenital abnormalities of the skull base that have been present since birth and may present at any age.

Rarely, previous injury, radiation treatment, or certain genetic conditions increasing the likelihood of skull base pathology.

Snyderman CH, Gardner PA. Endoscopic Skull Base Surgery. 2nd ed. Thieme; 2020.

When to seek help

When to arrange review

Seek specialist review for one-sided nasal symptoms that persist or are not explained by common sinus disease, clear watery nasal discharge, any visual change in association with nasal symptoms, or an unexplained nasal or sinus lesion found on imaging. These presentations benefit from early ENT assessment to guide further workup and ensure appropriate management.

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Treatment

Treatment overview

Management is highly individualised and depends on the nature, location, and size of the condition. Where surgical intervention is appropriate, endoscopic approaches are used where possible, allowing access through the nose without external incisions. A multidisciplinary team including neurosurgical and, where relevant, oculoplastic colleagues is involved when required. Not all skull base findings require surgery, and the management pathway is determined following thorough assessment.

Choosing your surgeon

Choosing your surgeon

Choosing the right specialist takes thought. Fellowship training, experience with the relevant condition, and contribution to teaching and research are all meaningful indicators. A public appointment at a tertiary hospital is another recognised marker of professional standing. Online reviews can be helpful, but they don't tell the whole story.