I. Individualized choice of treatment for skull base tumors (I) The social basis of individualized treatment With the development of society and the progress of science and technology, people’s thinking mode has also undergone a great change. At present, people-oriented, improving the quality of patient’s survival, and reducing the medical cost have become the goals pursued by doctors. From the previous single means of treatment, the pursuit of surgery, large, fast, all cut tumor to a variety of means, multi-disciplinary joint treatment. Minimally invasive surgery reduces complications, lowers the disability rate, improves the quality of patient’s survival, and solves the patient’s pain as the therapeutic goal. Instead of unilaterally pursuing total excision of tumor, radiotherapy and chemotherapy should be given selectively according to the patient’s age and physical condition. Therefore, the choice of treatment modality and surgical access should be based on the operator’s expertise in surgical access and technology, the patient’s systemic status, the family’s economic status, the psychological status of the patient and his family, and whether there are any special requirements, etc., so that personalized choice of treatment plan has become the duty of the physicians in the society nowadays. (The material basis of personalized treatment 1. Individual differences Different races, ages, genders and occupations have different incidence rates and parts of tumors, which have different degrees of tolerance, sensitivity, treatment and prognosis. Different tumors have individual differences, i.e. tumor heterogeneity, including genetic heterogeneity, functional heterogeneity, anatomical heterogeneity, spatial heterogeneity and temporal heterogeneity. Genetic heterogeneity refers to the interpretation of tumor properties and prognosis at the level of tumor molecular pathology, and some indicators, including O6-methylguanine-DNA methyltransferase (MGMT), epidermal growth factor receptor (EGFR), etc., are able to reveal the biological properties of tumors. Functional heterogeneity is also closely related to the biological characteristics of tumors, different tumors have different biological activities, i.e., different clinical manifestations, different ways of destruction, invasion or extrusion of surrounding structures, and different therapeutic treatments and prognoses, e.g., the invasiveness of pituitary adenomas is related to the high expression of CD147, Galectin-3 (gal-3) and microvessel density (MVD). Anatomical heterogeneity refers to the fact that tumors often develop in their specific anatomical sites, such as meningiomas, which develop within the dura mater of the central region of the skull base; chordomas, which develop in the slope region; pituitary adenomas and craniopharyngiomas, which develop in the saddle region; trigeminal fibromas, which are found in the plexus of the pre-synaptic ganglion and in the structures of the semilunar ganglion; chondrosarcoma, osteochondroma, which develops in the base of the skull, which disrupts the base of the skull to develop in the intra- and extracranial directions; and cavernous angiomas, which are confined to the parasagittal space of the side. The tumor is limited to one side of the paraspinal space, and so on. Spatial heterogeneity refers to the incidence of tumors in different geographic regions and races, the type of tumor development, and not exactly the same response to the same treatment. Temporal heterogeneity refers to the fact that the proliferation cycle of tumor cells has its own characteristics, and the same kind of tumor is not the same. Due to the different biogenic properties of tumors, attention should also be paid to the choice of treatment strategies. Rationalization of the treatment of skull base tumors The treatment of skull base tumors should be rationally selected according to the comprehensive factors such as the condition, systemic condition, family requirements, etc. There are surgical resection, radiotherapy, chemotherapy, traditional Chinese medicine treatment, immunotherapy and other means. It is not the case that surgery is needed immediately after the diagnosis of tumor, nor is it the case that radiotherapy and chemotherapy are given directly without considering the side effects, nor is it the case that the fear of active treatment will bring new complications or side effects, and then go to the other extreme, giving up the treatment for the one-sided pursuit of safety. Taking pituitary adenoma as an example, prolactin adenoma, regardless of macroadenoma or giant adenoma, is preferred to bromocriptine treatment, through a period of time treatment, not only can make the tumor volume shrink, but also make the PRL level drop significantly. When the PRL level remains normal for at least two years, the tumor volume can be reduced by more than 50%, however, stopping the treatment can lead to an increase in tumor volume and the recurrence of hyperprolactinemia, so the drug treatment for patients with prolactin adenomas must be closely followed up if the drug is reduced or discontinued. Pineal region germ cell tumor, due to the complexity of its anatomical location, it is adjacent to the midbrain and important large blood vessels such as the internal cerebral vein, basilic vein, and large cerebral veins, craniotomy is more risky, with a higher disability and mortality rate, and it is easy to subarachnoid dissemination, but it is sensitive to radiation therapy, so it is necessary to cooperate with the whole-brain radiotherapy and chemotherapy at the same time of targeted radiotherapy. With the rapid development of microsurgical technology, the application of intraoperative neurophysiological monitoring and the continuous improvement of postoperative nursing care, the total excision rate of the tumor is as high as 98%, and the retention rate of the facial nerve, the trigeminal nerve and the cochlear nerve is significantly improved after the operation.Samii has reported that in the surgical treatment of 1,000 cases of acoustic neuroma, the total excision rate of the tumor was 98%, and the cochlear nerve anatomy was preserved. The total tumor resection rate was 98%, the anatomical preservation rate of cochlear nerve was 68%, and the functional preservation rate was 39%. Pollock reported on the outcome of 87 cases of unilateral acoustic neuroma, in which the patients were divided into surgical and Gamma Knife groups, of which 40 underwent microsurgery and 47 received Gamma Knife treatment, and it was found that the incidence of delayed facial nerve disorders was 52% in the surgical group and 23% in the Gamma Knife group, respectively. Thus, although microsurgery is still the treatment of choice for acoustic neuromas, Gamma Knife is another effective treatment for small acoustic neuromas due to its demonstrated efficacy in preserving the function of the auditory, facial, and trigeminal nerves, as well as the relatively high rate of tumor growth control at long-term follow-up. Therefore, the treatment of skull base tumors should be individually designed, and a treatment method that best suits the patient should be selected according to the biological characteristics of the tumor, its size, location, growth pattern, blood supply, imaging characteristics, and the requirements of the family and the patient.