Skull Base Brain Tumor

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome, and I hope everyone's having a great day. I'm Deborah Howell, and today we'll be talking about skull base brain tumors and treatments with two very special guests. Dr. Jason Liauw is the Medical Director of the MemorialCare Neuroscience Institute at Saddleback Medical Center. His specialties are neurosurgery and spine surgery. Also joining us today is Dr. Ashley Balaker, an otolaryngologist at Head and Neck Associates of Orange County and MemorialCare Saddleback Medical Center. Dr. Liauw, let's begin with you, if I may. Can you possibly tell us what a skull base brain tumor is?

Jason Liauw, MD: A skull base brain tumor is just a segment of brain tumors that are usually more complicated, given that they are located at the base of the skull, essentially. It's basically at the bottom of the brain, to put it in kind of more lay terms. So a lot of times they involve a neurosurgeon and an otolaryngology surgeon for approaches to these tumors. And so they can be a little bit more complex with regards to their resection, which is why it requires two sub-specialties.

Deborah Howell (Host): And doctor, what causes skull base brain tumors?

Jason Liauw, MD: There is no actual real, I would say, known cause. There are some potentially genetic underpinnings of some of these skull base brain tumors, but there's still no real general cause. A lot of it is just unfortunate luck.

Deborah Howell (Host): Dr. Balaker, are there any symptoms associated with skull base brain tumors?

Ashley Balaker, MD: Being at the base of the skull, that's where most of what we call the cranial nerves exit the skull. And these nerves are responsible for things like your hearing, your balance, the movement of your face. Some of these nerves also control your eye movements. So oftentimes patients will first present with a symptom associated with an effect on one of those nerves. I commonly see patients come into the clinic complaining of hearing loss or ringing in one of their ears. We always take that as a warning sign when only one side is affected versus the other, because that can be a sign of a growth at this location. Sometimes patients will report changes in their vision or double vision. So those are some of the more common symptoms patients may first present with.

Deborah Howell (Host): And what steps does someone take if they suspect they may have a skull base brain tumor?

Ashley Balaker, MD: Well, anytime that a patient is experiencing symptoms related to anything in the head and neck area, as well as symptoms like headache that doesn't go away, changes in their neurologic function, first of all, they should see their primary care doctor, and that's usually where we're going to get most of our referrals for. When the primary doctor identifies that there really is a problem there and refers them to see either an otolaryngologist or refers them directly to a neurosurgeon for consultation. So I would encourage those patients if they're experiencing persistent symptoms to reach out to their doctor as a first step.

Deborah Howell (Host): Absolutely. If anything is wonky, just go to your doctor and he will take care of it and refer you to a specialist if necessary. Now, what types of treatments are available for skull base brain tumors?

Ashley Balaker, MD: Most of these tumors are going to be, if they do require treatment, and that's an important point, some of them actually do not need to be treated initially. I have quite a few patients who have very small, benign tumors that we actually watch over time to see if they are growing or not, especially if they're not causing significant symptoms. But patients who do require treatment, most of them are either going to have surgical removal or there are treatments available that involve a targeted type of radiotherapy or radiation treatment for the tumor.

Deborah Howell (Host): And back to you, Dr. Liauw, what kind of specialist or specialists work together to treat skull base brain tumors?

Jason Liauw, MD: Oftentimes for these tumors, it is a kind of a co-surgery between neurosurgeons and otolaryngologists, just because it actually does involve sub-specialization and specialized skills that each bring to the table, both in essentially getting the corridor of access, and the other side, taking out the tumor and dissecting it off the nerve in a careful fashion. There are several, you know, institutions around the country where that, where this happens on a regular basis. Both Dr. Balaker and myself trained at these sub-specialized institutions, and so it is kind of a sub-sub-specialization within each of our fields.

Deborah Howell (Host): And what's recovery like for patients after treatment, and is there therapy or rehabilitation?

Jason Liauw, MD: A lot of times we prepare our patients, because recovery does take several days on the inpatient side. And then on the outpatient side, the recovery, a lot of times what we look for is recovery of facial function, recovery of hearing, any of those things that could be impacted by the surgery can take usually even up to several months to recover or recover up to their highest potential. So yeah, it's just it's these are again more complicated surgeries which require a full team approach. We have not only physical therapists but speech therapists who work with the patients after the surgery to improve their recovery and accelerate their trajectory of recovery. And again, that's kind of why we're trying to bring all these different sub-specializations together to kind of give the most optimal care for patients with these skull base tumors. A lot of times, again, these patients do still look for centers that offer this. And so that's what we're trying to advertise to patients in a sense, is that this does exist in their own community. A lot of times that's not really broadcast to patients very well.

Deborah Howell (Host): I think it's always more effective to work as a team rather than in silos. And Dr. Balaker, he referenced in your communities there is availability of these kinds of services, so can you tell us a little bit about the new MemorialCare Neuroscience Institute at Saddleback Medical Center, and feel free to jump in as well, Dr. Liauw.

Ashley Balaker, MD: At Saddleback Medical Center, specialists like myself and Dr. Liauw are forming together to create a team that will work in a coordinated fashion for these cases. So we all see the patient, review the patient's symptoms and their testing, and develop a plan as a group on what the optimal treatment is for that patient. If patients need reconstructive surgery, there is also a reconstructive surgeon, Dr. Lu, who's a part of this institute. So depending on the access and the type of surgery the patient may need, they may also involve a reconstructive surgeon in that effort. So we're really happy to have all these people together that can offer a team-oriented approach for these patients' cases and give them the best outcomes possible.

Deborah Howell (Host): Dr. Liauw, did you want to add anything to that?

Jason Liauw, MD: Yeah, I think the only thing I would add is that both Dr. Balaker and myself come from two very large groups. In fact, probably the two largest groups in each of our sub-specialized fields in Orange County, both in neurosurgery and otolaryngology. So what you're seeing is essentially kind of multi-talented surgical groups with each with their own sub-specializations coming together. And I think that within our groups, there is a lot to offer so that we can essentially create what we've trained in in higher level tertiary care academic centers and bring that to the community. And I think that's an elevation that we're seeing, that a lot of patients are not traveling outside of Orange County as much anymore because essentially they can get the highest level of specialization within their own communities.

Deborah Howell (Host): And it sounds like it's always so much easier for people to operate in their own backyard when they can get to work and get to their specialty treatments at the same time in their own neighborhoods. We want to thank you so much, Dr. Balaker and Dr. Liauw, for your time today. We really do appreciate it. And for more information or to listen to a podcast of this show, please go to memorialcare.org. That's all for this time. I'm Deborah Howell. Thank you for listening and have yourself a great day.