Skull base surgery
hub, with additional designation as a national centre for airway reconstruction. Patients are referred from across London, the wider UK and internationally. It is one of only two centres nationally offering comprehensive, co-located care for tumours of the brain, skull base, and associated structures, encompassing the full pathway from diagnosis through to definitive treatment and reconstruction. The service delivers expertise across the full spectrum of skull base pathology. This includes sinonasal tumours, both benign and malignant, such as squamous cell carcinoma, adenocarcinoma, sinonasal undifferentiated carcinoma and other rare malignancies involving the anterior skull base, an area of recognised specialist focus. Intracranial skull base tumours, including meningiomas and chordomas, are managed alongside lateral skull base and temporal bone lesions, such as external auditory canal malignancies, paragangliomas and glomus tumours requiring complex temporal bone resection. The service also treats cerebellopontine angle tumours, including vestibular schwannomas, as well as neck and cranial base lesions such as paragangliomas and carotid body tumours. Pituitary tumours requiring surgery, orbital tumours including orbital meningiomas, and other rare entities are integral to the unit’s case mix. A defining strength of the service lies in its
reconstructive capability. The team is nationally recognised for advanced reconstruction, supported by a full complement of plastic surgeons skilled in microvascular free flap techniques, particularly for complex skull base
defects with intracranial exposure. Surgery is delivered at Charing Cross Hospital, the Trust’s designated site for neurosurgery, cranial neuro-oncology and skull base surgery. Dedicated head and neck and neurosurgical wards, alongside specialist peri-operative infrastructure, enable seamless multidisciplinary care. This integrated model underpins the unit’s role as a national referral centre, ensuring coordinated, safe and equitable care for patients with rare and complex skull base conditions.
Composition of the MDT The skull base MDT at Imperial College Hospitals is composed of highly trained consultant surgeons with fellowship-level training, each practising distinct yet overlapping aspects of complex skull base surgery across head
and neck, rhinology and neurosurgery. This integrated surgical model enables true subspecialty collaboration, while maintaining depth of experience in rare and technically demanding diseases. The team is supported by reconstructive microsurgeons with a high-volume free flap practice, ensuring comprehensive management of complex defects. Specialist input is provided by consultant
radiologists with advanced capabilities in both diagnostic and interventional neuroradiology, alongside histopathologists with subspecialist knowledge in the diagnosis of rare and complex skull base pathology.
Clinical oncology delivers radiotherapy,
systemic chemotherapy, and immunotherapy within the Trust, while also advising referring MDTs on standards-of-care and emerging treatments, facilitating local delivery where appropriate in order to optimise patient convenience. The MDT is further strengthened by a highly
specialised allied health workforce, including specialist nurses across skull base, head and neck, endocrine, rhinology, and neurosurgery, as well as speech and language therapists, audiologists, dietitians, physiotherapists, and restorative dentists. The nature of skull base disease and its treatment means patients may experience significant functional impairment (affecting speech, swallowing, hearing, facial function, airway and overall physical recovery) either because of the disease itself, or it’s treatment. These teams play a central role in structured
rehabilitation and recovery, working proactively to restore patients, wherever possible, to their pre-treatment functional baseline. This coordinated, longitudinal support ensures not only safe delivery of complex interventions, but also meaningful recovery, optimised quality of life and continuity of care beyond the operative episode.
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