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

Ezequiel Goldschmidt; Joseph D. Chabot; Hanna Algattas; Stefan Lieber; Nicholas Khattar; Ana C. I. Nakassa; Federico Angriman; Carl H. Snyderman; Eric W. Wang; Juan C. Fernandez-Miranda; Paul A. Gardner

doi:10.1055/s-0039-1694968

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2020; 81(06): 673-679
DOI: 10.1055/s-0039-1694968

Original Article

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

Ezequiel Goldschmidt

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Joseph D. Chabot

²Department of Neurosciences, Centracare Clinic, St. Cloud Hospital, St. Cloud, Minneapolis, United States

,

Hanna Algattas

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Stefan Lieber

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Nicholas Khattar

³Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, United States

,

Ana C. I. Nakassa

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Federico Angriman

⁴Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

,

Carl H. Snyderman

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Eric W. Wang

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Juan C. Fernandez-Miranda

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

,

Paul A. Gardner

¹Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

› Author Affiliations

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.

Keywords

seizures - craniotomy - endonasal endoscopic approach - skull base tumors

Full Text

References

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