Skull Base Surgery

Skull Base Surgery

Anterior skull base surgery refers to a group of advanced surgical techniques used to treat conditions affecting the interface between the brain and the nasal cavity (the anterior skull base). These approaches are commonly used for the management of benign and malignant tumours in the anterior cranial fossa such as meningiomas, esthesioneuroblastomas, and other sino-nasal malignancies, cerebrospinal fluid (CSF) leaks, and other complex skull base disorders. This approach is also used commonly for pituitary tumours and other skull base pathologies such as chordomas, Rathke's cysts, craniopharyngiomas and chondrosarcomas. Dr Ram Sivasubramaniam is one of the few well trained endoscopic skull base surgeons in Sydney with a regular operating at Concord and Macquarie University Hospitals.

The endoscopic approach is performed through the nasal passages using high-definition cameras and specialised instruments. This minimally invasive technique avoids external incisions and provides excellent visualisation of critical structures, allowing precise tumour removal or defect repair while minimising disruption to surrounding tissue. This involves collaboration between Dr Sivasubramaniam and his neurosurgical colleagues, utilising both endoscopic (through the nose) and sometimes open or transcranial techniques to safely access and treat disease that extends beyond the reach of a purely endoscopic procedure.

These procedures are highly specialised and are tailored to the individual patient based on the location, size, and nature of the condition being treated. The goals of surgery are to achieve complete disease management, preserve neurological function, and restore the integrity of the skull base.

Dr Ram Sivasubramaniam is the chair of the Skull Base and Pituitary MDT (Multidisciplinary clinic) at Concord General Hospital, where almost all complicated skull base cases are discussed with other skull base surgeons, radiation oncologists, radiologists, oncologists and allied health staff. Dr Ram Sivasubramaniam collaborates regularly with his skull base neurosurgical colleagues (Dr Damodaran & Dr Thomas) for these cases at Concord Hospital and Macquarie University Hospital. He also provides the same service for the St George Hospital with the other neurosurgical colleagues.