The Skull Base Center at Duke Health blends comprehensive, multi-disciplinary and responsive care management, elite surgical skills and the most advanced treatments for conditions affecting the bones, glands, nerves and tissues within the skull base. As a result of this multi-faceted approach, the center also has a long track record of positive outcomes.

Part of this team’s success is a strong focus on evidence-based best practices gathered from both pre-clinical and clinical studies involving patients and patient data.

A recent multidisciplinary collaboration from researchers at the Duke Health’s Skull Base Center, the Department of Head and Neck Surgery & Communication Sciences and the Department of Pharmacology and Cancer Biology has led to the development of a human cell line and a mouse model of esthesioneuroblastoma, also known as olfactory neuroblastoma.

The cell line and mouse model are laboratory tools that give researchers and clinicians the ability to identify molecular targets and to develop, test and refine targeted drug therapies both in vitro and using the mouse model. The model, published in the journal Cancer Cell, can also be replicated by other research teams, enhancing its visibility and promoting further research to expand the understanding of this rare cancer.

Additionally, this team identified genetic similarities between esthesioneuroblastoma, which is a rare nasal cavity cancer, and more common lung neuroendocrine cancers, for which targeted therapies have already been developed. This discovery opens the door to applying therapies designed for more prevalent cancers such as lung cancer to the treatment of esthesioneuroblastoma. More rare cancers like olfactory neuroblastoma, often referred to as "orphan cancers," typically lack sufficient research funding, which hampers disease specific advancements in treatment and outcomes.

This multidisciplinary collaboration aims to uncover new molecular targets for treatment, ultimately improving both overall survival and disease-free survival for patients facing this challenging cancer.

According to Ralph Abi Hachem, M.D., director of the Skull Base Center, findings from this research may pave the way for personalized and targeted therapies, adding to the current treatment options of surgery, radiation therapy and chemotherapy.

In terms of clinical research, a recent Merck-funded trial in the Duke Health Skull Base Center, conducted in partnership with Johns Hopkins Medicine, examined the relationship between human papillomavirus (HPV) and sinonasal squamous cell carcinoma. Building on research that showed people with HPV-positive sinonasal cancer tend to have a better prognosis than those with HPV-negative cancer, Skull Base Center physician-scientists followed people before, during and after treatment to determine if certain behaviors put people at risk for contracting high-risk HPV and to see if some therapies work differently or better based on someone’s HPV status.

The trial recently concluded and data analysis is currently in progress, which will inform an upcoming publication of the findings.

The Skull Base Center at Duke Health is a recognized leader, both nationally and internationally, in the diagnosis and treatment of cerebrospinal fluid (CSF) leaks. By harnessing the full expertise of the health system, the center has developed comprehensive care pathways for patients with CSF leaks. Duke’s approach includes a range of advanced surgical techniques to repair skull base defects, achieving optimal outcomes with low recurrence of the CSF leak compared to existing literature. In addition, the Duke Health Skull Base team has pioneered novel flap techniques for reconstructing the skull base, minimizing morbidity and enhancing recovery.

Patients at Duke Health receive comprehensive care, which includes screening for conditions like increased intracranial pressure and brain vein narrowing (transverse sinus stenosis) that could contribute to their symptoms. Using magnetic resonance venography (MRV), specialists can detect vessel stenosis early. If identified, neurovascular neurosurgeons can perform catheter-based stenting to relieve the pressure before a CSF leak occurs or recurs and to reduce the intracranial CSF pressure. Additionally, patients meet with neuro-ophthalmologists who assess their optic nerves and visual fields to ensure there is no vision loss caused by elevated CSF pressure.

Duke’s neuroradiologists are world renowned for their expertise, using cutting-edge imaging techniques to precisely locate CSF leaks and guide minimally invasive repairs. The center is also a pioneer in managing spinal CSF leaks, with neuroradiologists being among the first to use autologous blood injections to form clots that seal leaks.

Center Director Abi Hachem highlights that the center’s ability to quickly initiate treatment and provide patients with seamless access to a multidisciplinary team—including otolaryngologists, skull base specialists, neuroradiologists, neurovascular neurosurgeons and neuro-ophthalmologists—can make a life-saving difference in conditions like CSF leaks or elevated intracranial pressure, where early diagnosis and timely intervention are crucial.

Comprehensive, multidisciplinary care is the cornerstone of the Skull Base Center’s approach. This is further strengthened by the team’s deep commitment to evidence-based medicine and continuous innovation.

According to Abi Hachem, integrating cutting-edge research directly into clinical care is pivotal. "By embedding research into our daily practice, we can not only refine patient management but also drive advancements that have the potential to transform the entire field," he says. This fusion of research and clinical expertise pushes the boundaries of treatment and ensures that patients benefit from the latest innovations.