Operative Time as a Modifiable Risk Factor for Skull Base Surgical Morbidity: A Literature Review

Operative time is an increasingly recognized modifiable risk factor for postoperative morbidity and mortality. Recent data from other surgical subspecialties points to a higher risk of major complications and a longer hospital stay in association with prolonged operative time. Despite the long average duration of skull base operations, the neurosurgical literature is scarce on this matter. Herein we report our institutional experience and discuss strategies for decreasing operative time and improving outcomes.

We present a review of the literature and report our experience with skull base procedures, especially focused on various surgical approaches for skull base tumors and methods to improve the safe efficiency of surgery.

Surgical exposure is the main hurdle of skull base operations, given the deep location of the targeted pathology and the surrounding critical neurological and vascular structures. Fortunately, there are many surgical adjuncts available to the neurosurgeon to facilitate surgical exposure while decreasing the duration of surgery, including the surgeon’s level of experience, use of early CSF drainage, whether via the basal cisterns, the use of intraoperative image-guided navigation technology, as well as strategically eradicating the tumor blood supply early on to facilitate removal. These strategies have led to decreased operative time overall and improved outcomes compared with historical controls. Operative time is gaining interest as a modifiable risk factor for surgical outcomes. While difficult to quantify, further studies into operative efficiency are warranted to decrease the morbidity of skull base operations and this presentation offers important insights as a foundation for further study.

 

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

Publication History

Article published online:
07 February 2025