Skull base surgery
subsequently secure consultant posts elsewhere often maintain close professional relationships with their mentors, fostering ongoing collaboration and facilitating the continued referral of complex cases back to the unit. The unit’s international reputation as a leading
European centre ensures a steady influx of high-calibre trainees seeking to refine their subspecialist skills prior to consultant practice. Alongside this, the consultant body maintains a strong academic profile, collectively producing a substantial volume of peer-reviewed research each year. Many members of the team hold higher
degrees, including PhDs and Masters qualifications, reflecting a sustained commitment to advancing the field. Together, this combination of clinical volume,
structured training, and academic output provides a robust foundation for the long-term sustainability of the service, ensuring continued excellence in the management of rare and complex skull base conditions.
Striving for continuous improvement Imperial College Healthcare NHS Trust provides a supra-regional skull base service with the capacity and capability to manage rare, complex and high-risk disease. The clinical teams work in a highly cohesive and collaborative manner, functioning as a unified multidisciplinary group with a shared commitment to delivering care that is nuanced, individualised, and at the forefront of technical practice. There is a strong collective pride in the
service, underpinned by a culture of continuous improvement and patient-centred care. Key points for practice:
n Referring patients: Referrals are accepted through multiple routes, including Two-Week Wait cancer pathways and secondary referral to the supra-regional MDT. Established national referral networks enable clinicians and, where appropriate, patients to access the service from across the UK, ensuring equitable access to highly specialised care.
n Diagnostics: Diagnostic work-up is comprehensive and delivered with urgency, supported by rapid access to MRI, CT and PET-CT imaging. This is facilitated by a highly specialised radiology team who prioritise skull base cases and create capacity where required. Biopsy pathways are similarly expedited through close coordination between surgical specialties, with advanced techniques (including image-guided navigation) routinely employed to ensure accurate and timely tissue diagnosis.
n Treatment: Operative planning is undertaken within a highly functional MDT, comprising surgical, oncological, radiological and pathological specialists, alongside a full complement of allied healthcare professionals. This ensures that treatment strategies are carefully tailored, combining oncological efficacy with preservation of function.
n Follow-up: Post-operative care and surveillance imaging are delivered at Imperial, with clear and structured communication to referring clinicians
regarding ongoing management and surveillance protocols, enabling shared care where appropriate.
Conclusion In summary, the skull base service at Imperial College Hospitals exemplifies the principles of modern skull base surgery and the advantages of subspecialty centralisation for rare, high-risk conditions. High procedural volume supports the
standardisation of complex techniques despite their inherent technical demands, contributing to improved disease-specific outcomes, preservation of function, and enhanced patient experience. This model reflects the broader benefits of concentrating rare and complex care within specialist centres, ensuring consistency, safety and high-quality outcomes for patients. CSJ
About the authors
Mr Cameron Davies- Husband, MBBS BSc (Hons) FRCS (ORLHNS) is a senior ENT/Head and Neck Consultant at Imperial College Hospitals and lead clinician of the
head and neck oncology MDT. He specialises in advanced and complex tumours of the skull base, neck and salivary glands, and is the Trust’s senior surgeon for advanced tumours of the sinuses. His training includes two higher oncology fellowships in craniofacial surgery. The mainstay of his practice comprises tertiary referrals of a complex nature. He is Assistant Editor for the Journal of Clinical Otolaryngology, and Principal Investigator for the PROTIS trial concerning proton therapy for sinus tumours.
Mr Mark S. Ferguson, PhD FRCS (ORL-HNS), is a highly experienced Consultant Rhinologist, Facial Plastic Surgeon and Anterior Skull Base Surgeon. He is Lead
Imperial is a recruiting site for the PROTIS UK Phase III RCT, comparing proton beam therapy (shown above) with intensity modulated radiotherapy to treat cancer of the nose and sinuses.
Clinician for ENT at Imperial College Healthcare and co-founder of the Imperial Facial Reconstruction Unit. His background includes a PhD in Molecular Oncology, a prestigious post-CCT fellowship in Rhinology and Skull Base Surgery, and national leadership roles including GIRFT lead for ENT in Northwest London. He has published widely, lectures internationally, and maintains an active research programme in rare skull base tumours.
July 2026 I
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