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J Neurol Surg B Skull Base 2015; 76(05): 390-396
DOI: 10.1055/s-0035-1549308
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Immediate and Delayed Complications Following Endoscopic Skull Base Surgery

Matthew R. Naunheim
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
,
Ahmad R. Sedaghat
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
,
Derrick T. Lin
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
,
Benjamin S. Bleier
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
,
Eric H. Holbrook
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
,
William T. Curry   *
3   Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Stacey T. Gray   *
1   Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

27 October 2014

12 February 2015

Publication Date:
15 May 2015 (online)

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Abstract

Objectives To characterize the temporal distribution and resolution rate of postoperative complications from endoscopic skull base surgery.

Design Retrospective review of patients undergoing endoscopic resection of paranasal sinus or skull base neoplasm from 2007 to 2013.

Setting Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center.

Participants Fifty-eight consecutive patients.

Main Outcome Measures Postoperative complications were categorized as cerebrospinal fluid (CSF) leak, pituitary, orbital, intracranial, or sinonasal. Complications were temporally categorized as “perioperative” (within 1 week), “early” (after 1 week and within 6 months), or “delayed” (after 6 months).

Results The most common perioperative complications were diabetes insipidus (19.0%), CSF leak (5.2%), and meningitis (5.2%), with resolution rates of 75%, 100%, and 100%, respectively. Overall, CSF leak occurred in 13.8% of patients and resolved in all cases. A total of 53.8% of all complications were evident within 1 week of surgery. Chronic rhinosinusitis was the most common delayed complication (3.4%). Hypopituitarism and delayed complications were less likely to resolve (p = 0.014 and p = 0.080, respectively).

Conclusions Monitoring of complications after endoscopic skull base surgery should focus on neurologic complications and CSF leak in the early postoperative period and development of chronic rhinosinusitis in the long term. Late-onset complications and hypopituitarism are less likely to resolve.

Keywords

complications - skull base surgery - cerebrospinal fluid leak - hypopituitarism - diabetes insipidus

* These authors contributed equally to the research and the preparation of the manuscript.


 

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