Complications of Skull Base Reconstruction

Abstract

The skull base is an anatomically challenging location that is unique in that it requires three-dimensional considerations when formulating a reconstruction plan. Various methods have been described for repair including open, endoscopic and endoscopic-assisted approaches. Each of these can have complications that can arise either directly from access to the lesion or defect, or indirectly arising from patient characteristics, anesthetic considerations, as well as postoperative care. It is of utmost importance for the surgeon to select the appropriate technique and surgical access depending on the location of the lesion as well as the patient's specific anatomic variations. In this chapter, we highlight morbidity and mortality arising from various anatomical locations encountered during access for repair of skull base defects as well as those that may arise from lumbar drain placement. We also highlight some treatment protocols from the literature that will aid in the management of these complications. Careful patient selection, review of preoperative imaging, and meticulous technique are of utmost importance to prevent life-threatening problems. Surgeons should have intimate knowledge regarding management as well as methods in place to minimize their occurrence.

Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea

“…Similarly, when assessing the appropriateness of outpatient endoscopic skull‐base surgery, it is important to note patient dependent factors, such as medical comorbidities, that potentially increase the risk for complications . At our institution, nearly all patients undergoing skull‐base repair are evaluated by our institution's preoperative anesthesia clinic.…”

“…Results showed overall high success rates consistent with previous studies of 90% success of primary and 97% of secondary repairs; additionally, the review noted a low reported complication rate of around 0.03%. Frequently documented complications from endoscopic anterior skull‐base surgery include CSF leak, transient and permanent neurological deficits, pneumocephalus, bleeding, intracranial infection, headache, anosmia, and death . In a meta‐analysis by Hegazy et al .…”

Inaccurate Assessments of Anterior Cranial Base Malignancy Following Nasoseptal Flap Reconstruction

“…1). [12][13][14][15] Clinical data collected included disease etiology, surgical technique, locoregional control, and postoperative radiologic assessments. Only patients with at least one postoperative surveillance scan with inaccurate assessment of residual or recurrent malignancy were included in the study.…”

Rhino-Neurochirurgie

“…Patienten mit einem deutlichem Übergewicht (erhöhter ventrikulärer Druck), mit Morbus Cushing (verzögerte Wundheilung) und nach Voroperation oder (Chemo-) Radiotherapie haben ein höheres Risiko postoperativer Liquorfisteln. Weitere Faktoren, die ein höheres Risiko für Komplikationen bei der Schädelbasis-Rekonstruktion anzeigen, sind: Alter des Patienten über 60 Jahre, kardiologische oder pulmonale Vorerkrankungen, Diabetes, bestehende intrakranielle Infektion [523,525]. Reduzierte Eingriffe an der Hypophyse haben oft einen Sonderstatus.…”

“…Ventrikels durch die operativ eröffnete Sella beobachtet [679]. Durch örtlichen Druck kann auch ein postoperatives intraselläres Hämatom zur Visus-Minderung führen [525]. Auf das Risiko einer Druckschädigung durch einer übermäßige Eingabe von Gewebe im Rahmen der Dura-Rekonstruktion wurde schon hingewiesen [79,133].…”