Skull base surgery
How the MDT works in practice Patients referred with suspected or confirmed skull base disease undergo a structured diagnostic pathway. For many, initial imaging and work-up are performed within Imperial College Healthcare NHS Trust; however, for those referred from external centres, investigations may already be completed and are reviewed centrally on receipt. The service provides rapid access to MRI, CT and PET-CT imaging, delivered within nationally recommended timeframes and using optimised protocols tailored to complex sinonasal and anterior skull base pathology. All imaging is reviewed by experienced head
and neck and neuroradiologists, ensuring that subtle but clinically significant findings (such as perineural spread or rare radiological patterns seen in uncommon skull base tumours) are accurately characterised. Where tissue diagnosis is required, biopsy is facilitated promptly, often using image guidance and endoscopic approaches through carefully planned surgical “corridors.” Close collaboration and shared operative access between surgical teams enable efficient diagnostic clarification and minimise delays to definitive planning. Given the volume and complexity of cases, the skull base MDT convenes weekly, aligning
with national standards set by NHS England and National Institute for Health and Care Excellence. This forum brings together head and neck surgeons, rhinologists, neurosurgeons, plastic surgeons, radiologists, oncologists, and allied specialists to review all relevant investigations and formulate consensus management plans. Operative strategies are developed collaboratively, ensuring optimal exposure, oncological clearance and reconstructive planning. Patients are typically managed within a
coordinated inpatient setting where required, with joint reviews from all relevant teams. Endocrine input is delivered via a parallel MDT, supporting pre-operative optimisation and peri- operative management of complex hormonal disturbances. Post-operatively, patients undergo baseline MRI imaging prior to discharge, with ongoing surveillance coordinated either locally or in partnership with the referring centre. Follow-up is primarily delivered through in-person review, with selective use of virtual consultations where appropriate. This integrated model ensures continuity
of care across diagnostic, operative and surveillance phases, while enabling shared management with regional centres to deliver safe, efficient and patient-centred care.
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