Skull Base Tumor Surgery: Personal Experience from Sarajevo

Objective: Contemporary skull base surgery started to be routinely used in Sarajevo, Bosnia-Herzegovina (BH) 11 years ago. We aim to present the first skull base tumor series of patients from BH and to analyze morbidity and mortality related to surgical approaches, extent of resection, and tumor histology.

Design: Retrospective-prospective, descriptive, clinical study with consecutive series of patients.

Patients and Method: We analyzed 93 patients with skull base tumors operated on by the author (KD) from January 2008–November 2011. The series also enrolled five patients with brainstem tumors (BSTs). The whole spectrum of skull base approaches was used including craniofacial, transpetrosal, ELITE, and endonasal transsphenoidal ones. Preoperatively, high-field MRI was always performed. Ten days after surgery, CT with contrast was obligatorily done. The first postoperative MRI was performed 3 months after surgery. The follow-up period was 3–48 months. We did not use any technique facilitating radical tumor resection (neuronavigation, neuroendoscopy, intraoperative MRI) or additional radiosurgical tumor treatment.

Results: During follow-up, 88 (94.5%) patients showed clinical improvement. Mortality rate was 3% (five patients, two with malignant lesions). Postoperative deterioration was seen in 6.5% of patients (two of them developed diabetes insipidus, and two others with resected BST became dependent). Meningiomas (37, 39%) and pituitary adenomas (26, 28%) were the most common lesions. A total resection was carried out in 89, 2% of cases.

Conclusion: The surgical outcome of complex skull base tumors can be acceptable in general neurosurgical department if operative strategy is appropriately selected.