Perioperative Considerations in Endoscopic Skull Base Surgery

Abstract

Purpose of the Review Present an overview of perioperative considerations specific to endoscopic skull base surgery necessary to maximize successful outcomes. Recent Findings The majority of perioperative considerations for endoscopic skull base surgery lack strong supporting evidence and frequently have varied use or implementation amongst institutions. A notable exception comes from a recent randomized controlled trial demonstrating the benefit of lumbar drainage in high-risk cerebrospinal fluid leaks. Summary Skull base surgeons must consider a multitude of perioperative factors. While many components of perioperative management are extrapolated from related fields such as endoscopic sinus surgery or open cranial base surgery, additional highquality studies are needed to delineate best practices specific to endoscopic skull base surgery.

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

“…This review investigated the role of saline nasal sprays, nasal irrigations, and postoperative nasal debridement and their roles in optimal postoperative ESBS management, as these tools may assist with reducing nasal crusting and increasing mucosal recovery. Evidence on the timing and efficacy of both saline nasal sprays and nasal irrigation after ESBS is currently limited to expert review, 4,6,8,92,93 suggesting the need for higher level studies to determine their role postoperatively. These studies must weigh the risks and benefits of each strategy, along with intraoperative CSF leak status and reconstruction type, when studying optimal regimens after ESBS.…”

“…In their review, Hussaini and colleagues also stated that most of their patients were admitted to the ICU postoperatively. 8 In their survey of 116 skull base surgeons, Roxbury et al showed that approximately 40% and 80% of surgeons routinely admit endoscopic transsphenoidal surgery (TSS) patients and those who underwent expanded skull base approaches to the ICU, respectively. 4 Bui and colleagues published the only study comparing outcomes following ICU versus non-ICU admission after ESBS.…”

“…The only studies identified either presented the authors' own practices or the results of a survey of skull base surgeons' practices. 4,6,8,92,93 Most surgeons varied the timing of initiation of irrigations depending on the extent of surgery and skull base defect that was repaired, on average 1-2 weeks following surgery. Irrigations were delayed for larger defects to allow more time for healing.…”

“…[5][6][7] Furthermore, only a few studies have investigated how different postoperative strategies may impact patient outcomes. 8 Therefore, in this evidence-based review, a number of important postoperative considerations for ESBS are discussed in the context of the current skull base literature in order to elucidate areas of consensus and uncover areas that may warrant further study. Of note, studies focusing on perioperative management of idiopathic/traumatic, congenital, and spontaneous CSF leaks are outside the scope of the current systematic review.…”

Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience

“…This is essential in the preoperative planning of surgical procedures and patient counseling. [4][5][6] CRS is a common disease that occurs in approximately 5.5 to 28% of the population. [7][8][9][10][11] It affects quality of life and carries the risk of intracranial complications if left untreated.…”