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.
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.
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%).
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.
Current affiliation for Dr. Kassam: University of Ottawa, Ontario, Canada.
Current affiliation for Dr. Prevedello: The Ohio State University, Columbus, Ohio.
Current affiliation for Dr. Carrau: Institute at Saint John's Hospital, Santa Monica, California.
Current affiliation for Dr. Thomas: Beth Israel Deaconness Medical Center, Boston, Massachusetts.
Current institution for Dr. Zanation: University of North Carolina, Chapel Hill, North Carolina.
Address correspondence to: Daniel M. Prevedello, M.D., Department of Neurological Surgery, The Ohio State University, N-1011 Doan Hall, 410 West 10th Avenue, Columbus, Ohio, 43210. email: email@example.com.
Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.10.JNS09406.
DehdashtiARGannaAKarabatsouKGentiliF: Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery62:1006–10172008
DogliettoFPrevedelloDMJaneJAJrHanJLawsERJr: Brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus19:6E32005
FahlbuschRSchottW: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg96:235–2432002
FrankGSciarrettaVCalbucciFFarnetiGMazzatentaDPasquiniE: The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery59:1 Suppl 1ONS50–ONS572006
KassamABGardnerPSnydermanCMintzACarrauR: Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus19:1E62005
KassamABMintzAHGardnerPAHorowitzMBCarrauRLSnydermanCH: The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large VA aneurysm: technical case report. Neurosurgery59:1 Suppl 1ONSE162–ONSE1652006
KassamABPrevedelloDMCarrauRLSnydermanCHGardnerPOsawaS: The front door to Meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach—technical considerations and clinical series. Neurosurgery64:3 Suppl71–832009
KassamABSnydermanCGardnerPCarrauRSpiroR: The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report. Neurosurgery57:1 SupplE2132005
KassamABThomasAJZimmerLASnydermanCHCarrauRLMintzA: Expanded endonasal approach: a fully endoscopic completely transnasal resection of a skull base arteriovenous malformation. Childs Nerv Syst23:491–4982007
LaarmanGJKiemeneijFMuellerRGuagliumiGCobaughMSerruysPW: Feasibility, safety, and preliminary efficacy of a novel ePTFE-covered self-expanding stent in saphenous vein graft lesions: the Symbiot II trial. Catheter Cardiovasc Interv64:361–3682005
OrigitanoTCPetruzzelliGJLeonettiJPVandevenderD: Combined anterior and anterolateral approaches to the cranial base: complication analysis, avoidance, and management. Neurosurgery58:4 Suppl 2ONS327–ONS3372006
PrevedelloDMThomasAGardnerPSnydermanCHCarrauRLKassamAB: Endoscopic endonasal resection of a synchronous pituitary adenoma and a tuberculum sellae meningioma: technical case report. Neurosurgery60:4 Suppl 2E4012007
SolariDMagroFCappabiancaPCavalloLMSamiiAEspositoF: Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks. J Neurosurg106:157–1632007