Risk of Venous Thromboembolism in Endoscopic Skull Base Surgery: A Systematic Review

Background: The risk of postoperative venous thromboembolism (VTE) remains an understudied aspect of endoscopic skull base surgery (ESBS). This study aims to comprehensively review VTE incidence in ESBS and to identify associated risk factors.

Methods: A systematic literature search was conducted according to PRISMA guidelines. Eligible studies were assessed for VTE rates, including pulmonary embolism (PE), deep vein thrombosis (DVT), and bleeding complications such as intracranial hemorrhage (ICH) and epistaxis. Statistical analyses were conducted to calculate pooled VTE incidence in total and each subgroup. Additionally, a descriptive analysis was conducted to assess the influence of various risk factors.

Results: Initially, our search yielded a total of 767 unique papers. After initial screening, we narrowed our selection to 127 articles for full review. Ultimately, 39 publications met our criteria, which specifically reported on the incidence of VTE or ICH during ESBS. The pooled VTE rate was 1.9% (95% CI [1.3, 2.9]). Subgroup analyses indicated a pooled PE rate of 0.9% (95% CI [0.5, 1.5]) and a DVT rate of 1.4% (95% CI [0.7, 2.8]). Further analyses identified an increased risk for VTE in meningioma 7.0% (95% CI [3, 15]), Cushing's syndrome 2.7% (95% CI [1.4, 5.1]), craniopharyngioma 2.8% (95% CI [1.3, 5]). Descriptive analysis revealed additional possible risk factors, including lumbar drainage placement exceeding a week, prolonged hospital stays of more than 2 weeks, individuals aged 79 and above, malignancies, perioperative endocrinopathies, elevated Caprini score above 5, and recent history of stroke. Bleeding complications included ICH at 1.4% (95% CI [ 0.7, 2.6]) and epistaxis at 1.5% (95% CI [0.5, 4]). While some evidence suggested that perioperative anticoagulation might mitigate VTE risk without increasing the risk of ICH, there was insufficient data to provide conclusive practice recommendations.

Conclusion: The incidence of VTE in ESBS is small but clinically notable. Patients with meningioma, Cushing's syndrome, craniopharyngioma, and chordoma may be at higher risk for VTE. These data may inform decision-making and guide future investigations to optimize patient outcomes in ESBS.

 

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

Publication History

Article published online:
05 February 2024