Complications of Skull Base Surgery

Abstract

Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. Surgical management of this area requires complex surgical planning and execution and is associated with a myriad of potential complications. The goal, however, remains the same-to effectively address the pathology with minimal complications.Walter Dandy initially described a combined craniofacial approach to an orbital tumor in 1942.1 Ray and McLean utilized this approach for the surgical management of retinoblastoma 2 years later. 2 In 1954, Smith et al reported the application of the craniofacial approach for resection of sinonasal tumors. Ketcham et al also reported a series of 89 patients with malignant skull base tumors resected through a craniofacial approach. This approach was associated with a low mortality rate of 3%. 3,4Later in the 20th century, endoscopy became to be more widely used in surgery. Endoscopy-assisted skull base surgery became the mainstay of surgical management of sinonasal and skull base tumors. Yuen et al reported a series of patients, with olfactory neuroblastoma, treated with endoscopy-assisted craniofacial resection, with minimal complications.5 Stammberger was one of the pioneers of complete transnasal endoscopic resection of anterior skull base tumors. 6Comparisons of craniofacial resection (CFR) and transnasal endoscopic resection (TER) have been performed by multiple groups. Most notably, Batra et al compared 16 patients who underwent CFR with 9 patients who underwent TER. Patients who underwent TER had shorter operative times, shorter intensive care unit stay, lower rates of major complications, and decreased mortality. 7Endoscopic approaches are applied not only to sinonasal and skull base malignancies but also to other disorders, such as encephaloceles, cerebrospinal fluid (CSF) leaks, mucoceles, and pituitary neoplasms. Advantages of endoscopic approaches include better visualization of the clivus and parasellar regions. These approaches also allow the surgeon to avoid manipulating intracranial structures such as the frontal lobe.Effective management of skull base pathology requires involvement of a multidisciplinary team. This team of otolaryngologists, neurosurgeons, plastic surgeons, ophthalmologists, radiation oncologists, medical oncologists, anesthesiologists, and rehabilitation specialists is vital to ensure optimal surgical results. This multidisciplinary approach is essential to decreasing complications and mortality.Commonly reported complications of skull base surgery include meningitis, CSF leak, visual changes, cerebral infarct, subdural hemorrhage, epidural abscess, hydrocephalus, chronic rhinosinusitis, sinonasal mucocele, hematoma, epistaxis, and death. The likelihood of these complications is largely dependent on the nature of pathology that is being treated, whether it be malignant diseases, such as esthesioneuroblastoma, or benign pathologies, such as a pituitary macroadenoma. Understanding of the possibility of t...

WITHDRAWN: Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

“…Drawback of autologous grafts are their reabsorption due to the continuous brain pulsation, their limitation in size to cover large defects, or risk of secondary infection [5,22]. CSF leaks can occur in around 8 to 28% in open surgical and endoscopic cases [5,7,8]…”

“…Moreover, surgical remodelling can be achieved by a vascularized pedicled nasoseptal or pericranial ap [5], leading to a variety of combinations ultimately resulting in single-, double-, or triple layers of anterior skull base reconstruction. Complications include cerebrospinal uid (CSF) leak, meningitis, intracranial abscess or tension pneumocephalus [7][8][9]. Depending on the size of the defect, especially when it involves a large portion of the cribriform plate and extending from the posterior table of the frontal sinus to the tuberculum sellae, rates of developing an encephalocele or CSF leak increase signi cantly [10].…”

Clinical and Radiological Profile and Early Outcome of Skull Base Surgeries in a Tertiary Care Center in Eastern Nepal

“…13,14 Commonly reported complications in the literature of skull base surgery include meningitis, CSF leak, visual changes, cerebral infarct, subdural hemorrhage, epidural abscess, hydrocephalus, chronic rhinosinusitis, sinonasal mucocele, hematoma, epistaxis, and death. 15 In our study, similar complications were noted.…”

Postoperative Venous Thromboembolism after Neurotologic Surgery

“…Neurotologic procedures are complex and inherently associated with the risk of local and systemic complications. 1 Postoperative venous thromboembolism (VTE) is a systemic complication that can potentially be life-threatening. In a large prospective clinical trial, 32% of patients undergoing elective neurosurgery without chemoprophylaxis developed VTE.…”