Immediate postoperative imaging after uncomplicated endoscopic approach to the anterior skull base: is it necessary?

Nadimi, Sahar; Caballero, Nadieska; Carpenter, Patrick; Sowa, Lauren; Cunningham, R. S.; Welch, Kevin C.

doi:10.1002/alr.21405

Cited by 19 publications

(16 citation statements)

References 16 publications

(30 reference statements)

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“…They attest that imaging is crucial for early detection of postsurgical complications . Other studies have recommended against its routine use . These studies state that positive postoperative findings on imaging only affect clinical management if patients present with neurological symptoms .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to these studies, others have rejected the routine use of early postoperative imaging after EVSBS. These authors have concluded that findings on postoperative imaging, in the absence of neurological symptoms, do not have an impact on the clinical management of these patients . A recent retrospective analysis evaluating the effect of immediate postoperative CT scan after uncomplicated endoscopic approach to the anterior skull base concluded that the routine use of postoperative imaging may be unnecessary in these cases .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ventral skull base surgery: Is early postoperative imaging warranted for detecting complications?

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic ventral skull base surgery: Is early postoperative imaging warranted for detecting complications?

et al. 2014

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“…Beyond these imaging guidelines, additional CT imaging is obtained with any acute change in mental status or vision to assess for postoperative complications such as hematoma, infarct, or pneumocephalus in the perioperative period (Figure ). In fact, some advocate for no use of routine imaging following cranial base surgery in the adult population citing no complications identified by imaging that were not already suspected based on clinical symptoms . This is not recommended by the authors in the pediatric population due to potential limitations in the ability of the pediatric patient to effectively communicate many of the clinical changes that would prompt imaging.…”

Section: Postoperative Carementioning

confidence: 99%

The expanded endonasal approach in pediatric skull base surgery: A review

London

Rangel

Walz

2020

Laryngoscope Investig Oto

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Objective: Surgery of the pediatric skull base has multiple unique challenges and has seen recent rapid advances. The objective of this review is to assess key issues in pediatric skull base surgery (SBS), including anatomic limitations, surgical approaches, reconstruction techniques, postoperative care, complications, and outcomes.Data Sources: PubMed literature review.Review Methods: A review of the literature was conducted to assess the challenges, recent advances, and reported outcomes in pediatric SBS.Results: The pediatric skull base presents multiple anatomic challenges, including variable patterns of pneumatization, narrow piriform aperture width, and narrow intercarotid distance at the level of the cavernous sinus but not the superior clivus. These issues may be particularly challenging in patients less than 2 years of age. Endoscopic endonasal approaches in the sagittal and coronal plane have been applied to the pediatric skull base while open approaches may still be necessary in the setting of extensive intracranial or orbital disease, as well as disease lateral to critical neurovascular structures. While the nasoseptal flap was initially called into question for pediatric cases, it has been shown through multiple reports to be a feasible and robust reconstructive option. Complications and outcomes often depend upon the pathology. In children, response to noxious stimuli, ability to avoid Valsalva, and adherence to nasal precautions is variable. The use of lumbar drains is more common in pediatric than adult patients.Conclusion: While the pediatric skull base presents unique challenges, outcomes data support that endoscopic endonasal approaches are a pertinent surgical technique in appropriately selected patients. Level of Evidence: 3aK E Y W O R D S endoscopic endonasal approach, pediatric skull base surgery, skull base reconstruction, surgical outcomes

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“…It is prudent to consult neurosurgery and to have the patient undergo postoperative imaging to assess for pneumocephalus and intracranial bleeding. Although routine imaging after uncomplicated skull base surgery has not been shown to alter postoperative management, 41 surgeons should consider iatrogenic leaks to be unexpected. Given the current medical and legal climates, thorough evaluation of this complication is indicated.…”

Section: Complications Managementmentioning

confidence: 99%