Seizure Risk following Open and Expanded Endoscopic Endonasal Approaches for Intradural Skull Base Tumors

Abstract

Objectives The incidence of seizures following a craniotomy for tumor removal varies between 15 and 20%. There has been increased use of endoscopic endonasal approaches (EEAs) for a variety of intracranial lesions due to its more direct approach to these pathologies. However, the incidence of postoperative seizures in this population is not well described. Methods This is a single-center, retrospective review of consecutive patients undergoing EEA or open craniotomy for resection of a cranial base tumor between July 2007 and June 2014. Patients were included if they underwent an EEA for an intradural skull base lesion. Positive cases were defined by electroencephalograms and clinical findings. Patients who underwent a craniotomy to remove extra-axial skull base tumors were analyzed in the same fashion. Results Of the 577 patients treated with an EEA for intradural tumors, 4 experienced a postoperative seizure (incidence 0.7%, 95% confidence interval [CI]: 0.002–0.02). Over the same period, 481 patients underwent a craniotomy for a skull base lesion of which 27 (5.3%, 95% CI: 0.03–0.08) experienced a seizure after surgery. The odds ratio for EEA was 0.13 (95% CI: 0.05–0.35). Both populations were different in terms of age, gender, tumor histology, and location. Conclusion This study is the largest series looking at seizure incidence after EEA for intracranial lesions. Seizures are a rare occurrence following uncomplicated endonasal approaches. This must be tempered by selection bias, as there are inherent differences in which patients are treated with either approach that influence the likelihood of seizures.

Surgical Outcomes of Endoscopic Endonasal Versus Transcranial Resections of Adult Craniopharyngioma: A Meta-Analysis

“…TCAs were advocated for use in laterally extending or purely intraventricular tumors. However, recent literature has shown endoscopic surgery for craniopharyngiomas with intraventricular extension shows similar outcomes to transcranial surgery [ 25 26 ]. Similarly, CSF leak rates were brought down with the use of nasoseptal flaps in this approach.…”

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

“…Finally, it must be emphasized that similar to other rare complications after endonasal surgery, 23 very little is still known about the risk factors associated with SPH. Although tumor size and apoplexy may increase risk, there are likely other undiscovered risk factors, and more research is needed to understand the pathogenesis of such a serious complication.…”

Superior Hypophyseal Artery Intraoperative Indocyanine Green Angiogram as a Predictor of Postoperative Visual Function After Endoscopic Endonasal Surgery

“…[1][2][3][4][5][6] The endonasal route has gained an important role in the surgical management of these lesions because it provides a strict midline approach with bilateral visualization of and unobstructed access to the optic chiasm. 1,7 Dissection of the tumor off the optic chiasm can potentially cause visual loss and while risk factors have been studied, [8][9][10][11][12] early identification of cases with likely postoperative deficits remains a challenge. Previous research has attempted to use intraoperative visual evoked potentials to assess optic function in real-time, but the results have remained inconclusive.…”