Welcome to the Johns Hopkins Skull Base Team, dedicated to treating acoustic neuromas and other tumors of the skull base.

Mission Statement of the Johns Hopkins Skull Base Team

The options for treating acoustic neuromas and other tumors of the skull base are a recent development of modern medicine. Though the related surgical procedures and radiotherapy techniques were first described years ago, many technical refinements have been developed over just the past 10 years.

In the early 1900's surgeons worked alone; the concept of a skull base "team" did not yet exist. Working at The Johns Hopkins Hospital, Harvey Cushing is recognized as the first to introduce the concept of a team approach to operative management of tumors of the nervous system in the first decade of the last century, emphasizing the need to simultaneously consider multiple systems and diverse therapies to achieve the best results (Goodrich J. A millennium review of skull base surgery. Childs Nerv Syst 2000, 16:669-85).
Building on the legacy of multispecialty approach to a challenging set of pathologies, The Johns Hopkins Center for Skull Base Surgery was founded in 1976.

The conceptual fathers were Dr. George T. Nager, world renowned authority on pathology of the temporal bone, then Chairman of Otolaryngology, and Dr. Donlin Long, then Chairman of Neurosurgery, who extended microsurgical skill to its fullest potential and brought multidimensional clinical experience to bear on treatment approaches. It was clear that the greatest advances could be made in this complex surgical area only by organizing overlapping specialties to make the most of their diverse skills.

This group of specialists has been organized in what has been termed since 1980, the Center of Expertise concept. In this organization centers are founded around highly specialized well-defined categories of disease. The ultimate goal holds that the center should provide all that a patient needs for the most comprehensive care for their particular disease. All is the important word. The center must provide whatever is best for the individual patient, not what individual participants know how to do. This means that every standard therapy must be available. The center must provide the option of all management approaches for a particular problem, the non-operative therapies including all forms of radiation, chemotherapy protocols if applicable, and access to investigational therapies if needed. Reasoned clinical approaches to skull base tumors can, as well, involve vigilant monitoring without intervention.

The center concept goes well beyond simple provision of an operative team. It should include comprehensive evaluation of patients and a cogent statement of recommendations, operative and perioperative care, and it should address the patient needs for restoration of form and maximum function. The team needs to be able to care for complications of any type whenever they occur. Moreover, in an academic institution, the center must play an educational role and should have a research base to answer important questions, particularly those related to natural histories and treatment effect--constructs that can only be addressed with longitudinal, comparative study.

At present we have only expert opinion to guide us in some of the controversial areas related to the treatment of acoustic neuromas and other skull base tumors. Because of the nature of many of the skull base tumors, it will take years of careful evaluation to get adequate answers. All clinicians involved in skull base surgical treatment should evaluate all patients, those operated upon and those not, and scrupulously report their status.
With the advent of new technologies in imaging, and operative and radiation management, it is increasingly clear the effective treatment of skull base tumors will require close interdisciplinary communication between clinicians involved in diagnostics or treatment. Our required partnership requires effective communication. The Johns Hopkins Skull Base team is now organized as a working group, with regular, interdisciplinary meetings. In meeting on a regular basis we find improvement of the interdisciplinary clinical treatment of patients with skull base diseases, evaluation of patient data, advancement of clinical and experimental research in the field of skull base surgery, and an organization of meetings for training and sponsoring scientific meetings.
Moreover, communication with patients benefit in that a single, consensus statement of treatment options can be provided to you, the patient.

The care of an international cohort of patients is entrusted to what has been an experienced multidisciplinary team of skull base surgeons, radiotherapists, neuroradiologists, neurologists, nurses, and other medical specialists. Our goal is to provide a complete range of services for the diagnosis, treatment, and rehabilitation of patients with cranial base lesions and to extend the reach of our services, both individually and collectively.