Skull base surgery
Benefits to patients Patients with suspected skull base disease benefit from rapid access to specialist assessment and streamlined diagnostic processes. The service is fully integrated within the NHS England Two-Week Wait cancer referral framework, enabling timely triage, imaging, and biopsy where required. At Imperial College Healthcare NHS Trust, there is effectively no waiting list for specialist review or operative planning, reflecting close collaboration between surgical specialties and shared access to diagnostic and operative resources. This ensures that investigations are undertaken promptly and by the most appropriate team. Centralisation within a high-volume specialist
unit reduces unwarranted variation in care across referring centres in Greater London and beyond. The established model of joint operating – bringing together complementary subspecialties – allows complex procedures to become standardised and reproducible. This translates into safer surgery, with improved preservation of critical neurovascular structures, higher rates of complete oncological resection, and reduced morbidity. Similarly, advanced reconstructive techniques for complex skull base defects support superior functional and aesthetic outcomes, contributing to meaningful recovery and long-term quality of life. The geographical reach of the service is
extensive, with referrals spanning from the far north of the UK to its most south-westerly regions, in addition to Gibraltar and the Channel Islands, as well as Wales. This breadth reflects both the rarity of these conditions and the strength of long-established referral networks developed over decades. The legacy of preceding surgical leaders has enabled robust systems of care that ensure patients in geographically remote or potentially underserved regions can access highly specialised treatment without fragmentation. MDT coordinators play a pivotal role in maintaining continuity, facilitating efficient information transfer, clinical handover and communication between centres. The wider team remains collegiate and highly accessible, ensuring that communication between clinicians and allied health professionals is fluid and responsive; particularly when clinical circumstances evolve or urgent input is required. Together, this coordinated, centralised model delivers consistent, high-quality and patient-centred care across the full continuum: from referral through to treatment and long-term follow-up.
Innovation at Imperial Innovation within the skull base service at Imperial College Healthcare NHS Trust is
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driven by a combination of advanced surgical techniques, high-volume reconstructive capability, and active participation in national research programmes. The unit’s approach reflects a clear commitment to adopting technologies and methodologies that demonstrably improve patient outcomes, while maintaining a rigorous, evidence- based perspective on emerging tools and interventions. The service has a long-standing history of pioneering combined ENT–neurosurgical skull base approaches, integrating endoscopic and craniofacial techniques tailored to tumour location and extent. This collaborative operating model allows the team to individualise surgical “corridors,” minimise morbidity and achieve optimal oncological resection while preserving neurological and sensory function wherever possible. In parallel, the unit employs virtual
surgical planning for complex maxillofacial and skull base reconstruction. Working in partnership with industry specialists such as Stryker Corporation and Brainlab, the team utilises advanced planning platforms to map extended maxillectomy and anterior skull base reconstructive procedures. This enables precise pre-operative modelling, optimising the location and extent of osteotomies, improving reconstructive accuracy and enhancing both functional and aesthetic outcomes.
Research and national collaboration Imperial plays an active role in national skull base and head and neck cancer research, reflecting its position as a leading academic and clinical centre. The unit is a recruiting site for the PROTIS UK Phase III randomised controlled trial, funded by Cancer Research UK and led nationally by David Thompson and Jason Fleming. Cameron Davies-Husband serves as Principal Investigator at Imperial. This involvement reflects a broader philosophy within the team: a commitment not only to delivering high-quality care, but to advancing the evidence base that underpins
it; particularly in the management of rare and complex sinonasal malignancies, where robust data are often limited. The PROTIS trial aims to compare proton beam therapy (PBT) with intensity modulated radiotherapy (IMRT) to treat cancer of the nose and sinuses. The trial is also interested in understanding whether PBT causes fewer long- term side effects and results in a better quality of life after treatment.
Future-proofing the service Imperial College Healthcare NHS Trust’s position as a supra-regional centre is sustained by consistently high operative volume and an extensive referral network. The service manages approximately 100–200 skull base cases per year, including referrals from across the UK, international patients and the private sector. This volume is notable given that comparable cases may present in only single digits annually in many other centres. Audit of the Trust’s lead oncological skull
base surgeon demonstrates that approximately three-quarters of operative practice is derived from external referrals, underscoring Imperial’s established role as a vanguard centre for complex, tertiary and quaternary care. As a result, the clinical practice of the skull base surgical team is largely focused on this highly specialised cohort. This case volume underpins a strong training and academic environment. The service hosts advanced clinical and research fellowships, attracting surgeons from the UK and overseas. These programmes provide exposure to combined ENT–neurosurgical operating, complex anterior skull base and sinonasal malignancy and advanced reconstructive techniques. In addition, the centre supports nationally appointed fellows in rhinology and head and neck surgery, both of whom are embedded within the skull base MDT and operative practice. Fellows actively participate in MDT decision- making, service development, and national research activity, gaining experience that would be difficult to replicate in lower-volume settings. Importantly, fellows who train at Imperial and
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