Maneuvers to Prevent Complications in Skull Base Surgery

Introduction: In skull base surgery, despite the great risk of perioperative complications, patients often have minor symptoms preoperatively. We should take maximum care for veins, perforators, and cranial nerves engulfed in the tumor. When a tumor is small, veins are often patent. Our maneuvers to prevent complications during skull base surgery are reported.

Materials and Methods: We performed 141 operations of skull base tumor from 2006 through 2011. We experienced 66 meningiomas, 47 schwannomas, 14 craniopharyngiomas, and 15 others. The preoperative estimation by 3-dimensional computed tomographic angiography is especially valuable in regard to the relationship among vessels, tumor, and skull. Dural incision should be made so as not to sacrifice any venous flow such as the lowest ascending vein, sphenopetrosal vein and sphenobasal vein. With the transpetrosal approach, the posterior return of the petrosal vein should not be obstructed. The tentorial incision should be made in the early stage of the procedure for devascularization as anterior as possible. The extended line of the posterior margin of the mandibular nerve is useful as reference for the tentorial incision line. The vascularized pericranial flap and abdominal fat graft are always used to prevent CSF leakage when watertight dural closure is impossible.

Results: Gross total removal was performed in 52 cases, subtotal removal in 61, and partial removal in 28. No mortality, no major complication, and no CSF leakage occurred.

Conclusion: The strategy to preserve normal structures will provide minimal complications during skull base surgery.