Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients
A review
Otolaryngology,
Search for other papers by Amin B. Kassam in
Current site
Google Scholar
PubMed
Search for other papers by Daniel M. Prevedello in
Current site
Google Scholar
PubMed
Otolaryngology,
Search for other papers by Ricardo L. Carrau in
Current site
Google Scholar
PubMed
Otolaryngology,
Search for other papers by Carl H. Snyderman in
Current site
Google Scholar
PubMed
Search for other papers by Ajith Thomas in
Current site
Google Scholar
PubMed
Search for other papers by Paul Gardner in
Current site
Google Scholar
PubMed
Search for other papers by Adam Zanation in
Current site
Google Scholar
PubMed
Search for other papers by Bulent Duz in
Current site
Google Scholar
PubMed
Ophthalmology, and
Search for other papers by S. Tonya Stefko in
Current site
Google Scholar
PubMed
Search for other papers by Karin Byers in
Current site
Google Scholar
PubMed
Search for other papers by Michael B. Horowitz in
Current site
Google Scholar
PubMed
Object
The development of endoscopic endonasal approaches, albeit in the early stages, represents part of the continuous evolution of skull base surgery. During this early period, it is important to determine the safety of these approaches by analyzing surgical complications to identify and eliminate their causes.
Methods
The authors reviewed all perioperative complications associated with endoscopic endonasal skull base surgeries performed between July 1998 and June 2007 at the University of Pittsburgh Medical Center.
Results
This study includes the data for the authors' first 800 patients, comprising 399 male (49.9%) and 401 female (50.1%) patients with a mean age of 49.21 years (range 3–96 years). Pituitary adenomas (39.1%) and meningiomas (11.8%) were the 2 most common pathologies. A postoperative CSF leak represented the most common complication, occurring in 15.9% of the patients. All patients with a postoperative CSF leak were successfully treated with a lumbar drain and/or another endoscopic approach, except for 1 patient who required a transcranial repair. The incidence of postoperative CSF leaks decreased significantly with the adoption of vascularized tissue for reconstruction of the skull base (< 6%). Transient neurological deficits occurred in 20 patients (2.5%) and permanent neurological deficits in 14 patients (1.8%). Intracranial infection and systemic complications were encountered and successfully treated in 13 (1.6%) and 17 (2.1%) patients, respectively. Seven patients died during the 30-day perioperative period, 6 of systemic illness and 1 of infection (overall mortality 0.9%).
Conclusions
Endoscopic endonasal skull base surgery provides a viable median corridor based on anatomical landmarks and is customized according to the specific pathological process. This corridor should be considered as the sole access or may be combined with traditional approaches. With the incremental acquisition of skills and experience, endoscopic endonasal approaches have an acceptable safety profile in select patients presenting with various skull base pathologies.
Abbreviations used in this paper:
AVM = arteriovenous malformation; BA = basilar artery; CA = carotid artery; CN = cranial nerve; EEA = endoscopic endonasal approach; ICA = internal CA; MPW = medial pterygoid wedge; VA = vertebral artery.
© Copyright 1944-2023 American Association of Neurological Surgeons