Endoscopic Skull Base Surgery: Complication Avoidance and Management

Introduction: Endoscopic skull base surgery is an emerging strategy for treating complex midline lesions of the cranial base. The two challenges of the approach and operation in general are avoiding and managing vascular injury and skull base reconstruction to avoid spinal fluid leak and potential infection. We report on a technique used in the endoscopic management of 21 complex tumors of the skull base.

Materials and Methods: Between 2006 and 2008, 21 complex cranial base tumors were resected using a fully endoscopic approach. The patient age range was 16 to 77 years. The pathology included eight meningiomas, five chordomas, six giant pituitary adenomas (> 4 cm in diameter), one sinonasal carcinoma, one juvenile angiofibroma. There were no neurovascular injuries. There were two cases of cerebrospinal fluid leakage. In one of these cases there was associated meningitis; reoperation and CSF diversion was ultimately required in both cases. The average hospital stay of these patients, excluding those treated for CSF leak issues, was 2.8 days.

Conclusion: Endoscopic surgery can be performed effectively and safely with minimal risk of neurovascular injury or CSF leakage. Appropriate precautions must be instituted to avoid the aforementioned complications. We describe various strategies for avoidance and repair of CSF leakage and management of carotid injury. In our experience, the risk of complications tends to be greatest in situations of reoperation and prior irradiation.