Extended Endoscopic Endonasal Approaches for the Skull Base: the Rate of Complications

Background: Endoscopic endonasal transsphenoidal surgery is a well-established approach for the sellar region. It has developed over the past decade, and the technique has been extended to provide access to different skull base lesions. The data for postoperative CSF leak, infection rate, and its risk factors in extended endoscopic endonasal approaches (EETA) are limited in the literature.

Materials and Methods: We have conducted a retrospective study to evaluate the complication rate of extended endoscopic skull base surgeries for patients operated at King Saud University Medical City, Riyadh, Saudi Arabia, from October 2014 to July 2020 with different skull base pathology. Pediatrics and adults, with a minimum follow-up of 1 month, were included. Age, gender, history of insert a preoperative CSF diversion, body mass index, extend of resection, postoperative CSF leak, postoperative infection, and other complications were evaluated. The collected data were analyzed using SPSS statistical program version 20 (Chicago, Illinois, United States).

Results: We included 79 consecutive patients who underwent extended endoscopic endonasal approaches for skull base lesions. The median age was 41 years (range: 5 months–79 years), 15 patients were pediatrics, 28 males and 51 females. The transplanum transtuberculum approach was performed in 50 cases, 12 transclival, 9 transcribriform, 5 transethmoidal, and 4 transpterygoid approaches. A gross total excision achieved in 53%, near-total excision in 8%, subtotal excision in 37%, and 2% had a decompression of the optic nerves. Early postoperative CNS infections developed in 16%, 76% of them had CSF leak. Among all the patients, 16% had postoperative CSF leak needed surgical management, while 8% had CSF leak treated conservatively. Among all patients who had CSF leaks, 42% were overweight, and 37% were obese. But 6% developed postoperative hydrocephalus, 80% of them underwent a transplanum transtuberculum approach. Also, 11% had diabetes insipidus, 55% of them where transient. Four patients developed panhypopituitarism, and two patients had adrenal insufficiency. The mortality rate was 1.2%.

Conclusion: An extended endoscopic endonasal approach is an excellent alternative option to the conventional skull base surgery. CSF leak with subsequent meningitis remains a major challenge.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021