Specialist skull base MDT · UK
Minimally invasive skull base surgery in the UK, through a specialist MDT.
Endoscopic endonasal, supraorbital eyebrow, retrosigmoid, middle fossa and translabyrinthine approaches - routed into an SBNS-recognised skull base centre, with the corridor chosen after the MDT rather than before.
Why patients choose us
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A specialist skull base MDT, not one surgeon alone
Skull base disease belongs in a joint ENT–neurosurgery clinic. We route you into an SBNS-recognised centre - Queen Square, King’s, Salford, Oxford, Cambridge, Southampton, Cardiff or Edinburgh.
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The approach is chosen after the MDT, not before
Endonasal, eyebrow, retrosigmoid, middle fossa or translabyrinthine - the corridor follows the pathology and your anatomy, not the surgeon’s habit.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What minimally invasive skull base surgery costs privately in the UK.
Indicative ranges across UK skull base MDT centres. Send the scan and letter and we quote firm figures across two or three options.
In short
A standard endoscopic endonasal pituitary resection privately: £30,000–£45,000, admission 3–5 nights.
| Procedure | Indicative range | Typical duration | Admission |
|---|---|---|---|
| Endoscopic endonasal pituitary resection | £30,000–£45,000 | 3–5 hrs | 3–5 nights |
| Endoscopic endonasal skull base (extended) | £40,000–£60,000 | 6–10 hrs | 5–10 nights |
| Supraorbital “eyebrow” keyhole craniotomy | £30,000–£45,000 | 3–5 hrs | 3–5 nights |
| Retrosigmoid keyhole (CP angle) | £35,000–£55,000 | 4–8 hrs | 4–7 nights |
| Middle fossa (hearing preservation) | £35,000–£55,000 | 5–8 hrs | 4–7 nights |
| Translabyrinthine (large vestibular schwannoma) | £35,000–£55,000 | 5–8 hrs | 4–7 nights |
| Skull base MDT consultation only | £350–£650 | 45 min | Same visit |
Prices vary by centre, by the named consultant skull base team, by the length of the operation, and by ITU and imaging use. Skull base surgery is also NHS-funded through the specialist centres - we help you weigh both routes honestly.
The problem
The right corridor, in the right MDT, at the right centre.
Skull base disease is one of the areas where centre and MDT genuinely matter - approach, reconstruction and long-term outcome all track with volume and joint working. We route accordingly.
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Told it needs a big open craniotomy?
Many midline lesions can now be done endonasally, and some lateral lesions through a keyhole. It is worth an MDT opinion before you consent.
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Offered surgery when radiosurgery might be enough?
Small vestibular schwannoma and some meningiomas can be observed or treated with Gamma Knife or CyberKnife. The MDT compares the options.
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Want a named skull base team?
Consultant neurosurgeon plus rhinologist for endonasal work, plus plastics for complex reconstruction - in a proper theatre, not a general list.
The journey
From MRI to MDT to recovery - what happens, in order.
One clinician holds your case from first message through MDT, surgery, ITU and MRI surveillance.
Phase 1 · Before surgery
MDT review and workup
Phase 2 · Admission and theatre
Days in hospital, then ward
Phase 3 · After
Recovery and surveillance
- 01
Before
You send us the scan and the letter
A short, confidential form plus your most recent MRI (and CT if you have one). Symptoms, timeline, any endocrine or vision changes.
- 02
Before
We come back with a shortlist
Within one working day: two or three UK skull base MDT centres, the likely approach, indicative pricing and what the MDT will need to see.
- 03
Before
MDT review and workup
High-resolution MRI, CT for bony detail, pituitary hormone profile, visual fields and audiogram as needed. ENT, neurosurgery and endocrine input before a plan is signed off.
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Admission
Admission and anaesthesia
Admission the day before or on the day. General anaesthesia, neuronavigation set up, intraoperative imaging where used.
- 05
Admission
The operation itself
Two to three hours for a straightforward endonasal case; eight to ten for a complex clival or CP angle resection. Meticulous dural and skull base reconstruction - nasoseptal or pericranial flap.
- 06
Admission
ITU or HDU, then the ward
Twenty-four to seventy-two hours on ITU or HDU for neuro-observation and fluid balance, then three to seven days on the ward.
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After
Recovery, imaging and surveillance
Office work at four to eight weeks, sport at eight to twelve, driving at four to six (DVLA notified if seizure or vision change). Interval MRI surveillance for years.
Typical end-to-end: 3–6 weeks from MDT to surgery. Return to office work: 4–8 weeks.
When it helps
When minimally invasive skull base surgery is the right step.
The pathologies where an endoscopic or keyhole corridor is now the standard of care - plus the one presentation that needs A&E, not a clinic.
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Pituitary adenoma
The commonest indication. Endoscopic endonasal transsphenoidal resection through the nostril and sphenoid sinus - no visible incision.
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Craniopharyngioma
Endonasal or transcranial depending on suprasellar extent, hypothalamic involvement and optic apparatus anatomy.
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Anterior skull base meningioma
Olfactory groove, planum sphenoidale and tuberculum sellae meningiomas - endonasal or a supraorbital eyebrow keyhole.
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Vestibular schwannoma (acoustic neuroma)
Retrosigmoid keyhole, middle fossa for hearing preservation, or translabyrinthine for larger tumours where hearing is already gone.
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Chordoma or chondrosarcoma of the clivus
Endoscopic endonasal is the workhorse for midline clival disease, often combined with proton therapy.
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CSF leak, encephalocele, optic decompression
Endoscopic endonasal repair of spontaneous or traumatic CSF leaks, encephalocele, and decompression of the optic nerve.
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Trigeminal schwannoma / sinonasal malignancy
Meckel’s cave lesions via endonasal or subtemporal; sinonasal malignancy with skull base extension via combined craniofacial work.
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Red flag: sudden vision loss, apoplexy
Acute severe headache with vision change or collapse can be pituitary apoplexy - same-day A&E and neurosurgery, not a clinic booking.
Approach options
One skull base, several corridors.
Each approach has a natural home in the anatomy. The MDT matches corridor to pathology, not the other way round.
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Endoscopic endonasal (EEA)
Through the nostril and sphenoid sinus to the sella and skull base. The workhorse for pituitary, craniopharyngioma, midline meningioma, chordoma and sinonasal disease.
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Supraorbital “eyebrow” craniotomy
A 2–3 cm incision hidden in the eyebrow. Keyhole access to the anterior fossa, orbit and suprasellar space for meningioma and small tumours.
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Retrosigmoid keyhole
A small suboccipital keyhole for cerebellopontine angle tumours - vestibular schwannoma, meningioma - and microvascular decompression.
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Middle fossa
For small intracanalicular vestibular schwannoma when useful hearing is present and worth preserving.
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Translabyrinthine
For larger vestibular schwannoma where hearing is already lost - sacrifices hearing for a direct facial-nerve-sparing corridor.
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Endoscopic-assisted microsurgical
Combines the operating microscope with the endoscope inside a traditional approach - improves visualisation around corners.
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Neuronavigation + intraoperative MRI/CT
Image guidance and, in select centres, intraoperative imaging to confirm resection before closure.
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Skull base reconstruction
Nasoseptal (Hadad-Bassagasteguy) flap, pericranial flap, temporoparietal fascia or free flap - the reconstruction that stops the CSF leak.
Our vetted UK network
A small panel of skull base MDTs, we picked them.
The centres we route into include Queen Square (UCLH), King’s College Hospital, Salford Royal, John Radcliffe Oxford, Addenbrooke’s Cambridge, Southampton, Cardiff and Edinburgh. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every skull base centre in our network.
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SBNS-recognised skull base MDT centre with joint ENT and neurosurgery
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Consultant skull base neurosurgeon and rhinologist operating together for endonasal cases
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Neuronavigation, high-definition endoscopy and intraoperative imaging available
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Plastic surgery input for complex reconstruction and free flaps
Safety and recovery
What to expect afterwards - honestly.
Skull base surgery is precise, technical work with real risks. In a high-volume MDT centre those risks are quantifiable, discussed in detail, and mitigated by design.
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CSF leak is the headline risk
Post-operative cerebrospinal fluid leak affects roughly 5–15% of expanded endonasal cases. A well-designed nasoseptal flap and multi-layer closure bring it down substantially.
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Meningitis is uncommon but tracked
When it happens, it usually follows an untreated CSF leak. Fever, neck stiffness and headache after skull base surgery are always assessed the same day.
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Endocrine changes after pituitary work
Diabetes insipidus and hypopituitarism can occur - often transient, sometimes permanent. Endocrine follow-up is part of the plan, not an optional extra.
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Vision can improve, or occasionally worsen
Decompressing the optic apparatus usually helps vision. Deterioration is rare but real, and consent covers it explicitly.
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Cranial nerve function is monitored
Facial nerve monitoring for vestibular schwannoma work, cavernous sinus nerves for lateral approaches, olfaction for anterior fossa. Preservation rates are procedure-specific.
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Hearing loss is expected in some corridors
Translabyrinthine sacrifices hearing by design. Middle fossa aims to preserve it. Retrosigmoid sits in between and depends on tumour size.
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Vascular injury is the rare catastrophe
Injury to the internal carotid artery in endonasal work is uncommon in experienced hands but can be devastating - one reason volume and MDT matter.
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Sinus symptoms after endonasal work
Crusting, congestion and altered smell for weeks to months is normal after endonasal surgery. Regular saline douching helps.
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Red flags after discharge
Clear watery drip from the nose, fever with headache, sudden visual change, seizure or new weakness - call the on-call skull base team or go to A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever corridor was used, the note from the skull base team keeps to the same shape.
A quiet reminder
Neurosurgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis, approach and MDT decision
Why the operation was done, which corridor was chosen, and the MDT that agreed the plan.
- 02 Technique
Approach, navigation and reconstruction
The precise approach - endonasal, eyebrow, retrosigmoid, middle fossa, translabyrinthine - plus navigation used and how the skull base was rebuilt.
- 03 Findings
Extent of resection and structures spared
Gross total, near total or subtotal resection, and which critical structures - optic nerves, carotid, facial nerve, pituitary stalk - were preserved.
- 04 Impression
Recovery, surveillance and next steps
Read this first: expected recovery, when driving and work resume, imaging schedule, and whether SRS, hormone therapy or further surgery is planned.
Recognised by major UK insurers
Cover for skull base surgery is usually authorised where medically indicated, subject to pre-authorisation, named consultant and centre approval. We confirm cover before booking, and route through the NHS where that is the better fit.
Frequently asked
Everything we get asked about minimally invasive skull base surgery.
Quick answers on which centres, which corridor, CSF leak risk, recovery and how to weigh surgery against radiosurgery.
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What is minimally invasive skull base surgery?
An umbrella term for keyhole and endoscopic approaches to tumours and other pathology at the base of the skull. Instead of a large open craniotomy, the surgeon works through the nostril (endoscopic endonasal), a small incision in the eyebrow (supraorbital keyhole), or a small opening behind the ear (retrosigmoid, middle fossa, translabyrinthine). The corridor is chosen to match the pathology, not the other way round.
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Where in the UK is this done properly?
In a specialist skull base MDT centre with joint ENT and neurosurgery - Queen Square (UCLH), King’s College Hospital, Salford Royal, John Radcliffe (Oxford), Addenbrooke’s (Cambridge), Southampton, Cardiff and Edinburgh are the recognised UK examples. Skull base surgery outside a proper MDT is not something we arrange.
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Is endoscopic endonasal surgery safe?
In experienced hands, yes - it is the standard of care for pituitary adenoma and much midline skull base disease. The main specific risks are a post-operative CSF leak (5–15%, reduced by nasoseptal flap reconstruction), endocrine changes after pituitary work, and - very rarely - injury to the internal carotid artery. Volume and MDT experience matter.
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How is the approach chosen?
By the skull base MDT, from the MRI and CT, the pathology suspected, the anatomy of your particular skull base, whether hearing or vision needs preserving, and where the tumour sits relative to critical vessels and nerves. Endonasal wins for midline; keyhole craniotomy or a lateral approach wins for lateral or CP angle disease.
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How long is the hospital stay and recovery?
Typically 24–72 hours on ITU or HDU followed by 3–7 days on the ward. Office work at four to eight weeks, sport at eight to twelve, driving at four to six weeks (with DVLA notification if there has been a seizure or a significant visual change). Long-term MRI surveillance is standard.
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What does it cost privately in the UK?
Roughly £30,000–£45,000 for a standard endoscopic endonasal pituitary resection, £40,000–£60,000 for an expanded endonasal skull base case, and £35,000–£55,000 for keyhole retrosigmoid, middle fossa or translabyrinthine work. Complex reconstruction, ITU stay and follow-up imaging sit on top. Firm quotes within one working day.
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Is it available on the NHS?
Yes - skull base surgery is funded on the NHS through the specialist skull base MDT centres listed above. The private route buys time to a named surgeon and choice of centre; it does not buy a different operation.
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What are the alternatives to surgery?
For small vestibular schwannoma and some meningioma, stereotactic radiosurgery (Gamma Knife or CyberKnife) is a legitimate alternative - sometimes better. For prolactinoma, medical therapy comes first. For asymptomatic small lesions, watch-and-scan is often correct. The MDT weighs all of it before recommending surgery.
Related treatments
Looking for something else?
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Endoscopic pituitary excision
Endoscopic endonasal transsphenoidal resection of pituitary adenoma.
Learn more -
Keyhole craniotomy
Small-incision craniotomy for select intracranial pathology.
Learn more -
Craniotomy
Conventional open craniotomy - when a bigger corridor is needed.
Learn more -
Microvascular decompression
Retrosigmoid keyhole for trigeminal neuralgia and hemifacial spasm.
Learn more -
All tests & procedures
Every test and procedure we arrange across the UK.
Learn more