Skull base surgery
Improving skull base disease outcomes
Imperial College Healthcare NHS Trust has a long-standing history of pioneering combined ENT–neurosurgical skull base approaches. In this article, Mr Cameron Davies-Husband and Mr Mark S. Ferguson provide an insight into the Trust’s integrated approach to delivering supra-regional excellence in skull base disease outcomes.
Low-volume, high-risk skull base and head and neck tumours demand highly specialised, skill-intensive care. Recognising this, the NHS England neurosurgery service specification (2019) defines these conditions as services that should be commissioned at a supra-regional level, concentrating expertise, infrastructure and multidisciplinary capability to optimise outcomes. This model reflects the complexity of disease biology, the technical demands of surgery and the need for coordinated peri- operative and adjuvant care.
National guidance further sets out best-
practice pathways aligned to the Faster Diagnosis Standard, facilitating timely investigation, diagnosis and triage of patients with complex cancer and skull base conditions. Early referral to centres of excellence is critical, ensuring that subspecialist teams operate within integrated, pathway-driven models of care tailored to these rare and challenging entities. Across guidance spanning neurosurgery and
otolaryngology–head and neck disciplines, there is consistent emphasis on cohesive, coordinated multidisciplinary teams. Such collaboration enables personalised care planning and is associated with improved survivorship, functional outcomes and long-term quality of life. At Imperial College Healthcare NHS Trust, we manage the full spectrum of malignant and benign head and neck tumours and associated conditions. Our MDT collaborates with partner hospitals across the UK to deliver cohesive, expert care.
In this article, we describe our approach to
centralising complex surgical services to ensure safe, equitable outcomes for patients.
About the service Skull base disease represents a heterogeneous group of rare and complex conditions for which true incidence is difficult to quantify. There is no single national skull base category within the UK cancer registry; instead, rarity must be inferred from the individual tumour groups that comprise this spectrum. While pituitary tumours are relatively common, only a minority require surgery each year, as highlighted in the NHS England pituitary adenoma evidence review. Sinonasal tumours with skull base
involvement are estimated at fewer than 500 cases annually according to Cancer Research UK (2025), while skull base sarcomas are exceptionally rare, with fewer than 20 cases per
Collaboration enables personalised care planning and is associated with improved survivorship, functional outcomes and long-term quality of life.
year reported by Sarcoma UK (2025). Collectively, these figures underscore the need for highly specialised expertise concentrated within a small number of centres. For over three decades, the skull base service at Imperial College Healthcare NHS Trust has been recognised as one of the UK’s leading units for complex craniofacial and skull base surgery. Historically, care was delivered across a small number of London-based centres, with Imperial playing a formative role in shaping the modern multidisciplinary model. Foundational surgical approaches (developed by Ketchum and Cheesman) helped define contemporary UK skull base practice. This heritage is characterised by early adoption of advanced craniofacial techniques, a strong culture of innovation and successive generations of surgeons contributing to national standards in neurosurgery and head and neck oncology. Today, the service functions as both a regional tertiary centre and a supra-regional referral
July 2026 I
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