Endoscopic Skull Base Surgery in the Elderly Population: The Effect of Pathology on Outcomes

Objective Endoscopic surgery in elderly patients has become a widely used technique for resection of skull base lesions. The effects of pathology and anatomic location on surgical outcomes have not been described in existing literature. The aim of this study is to evaluate if underlying pathology (pituitary vs. nonpituitary, and malignant vs. benign) is associated with increased intraoperative and postoperative complications for endoscopic resections in the elderly population.

Study Design Retrospective review.

Methods A database of 1,639 patients undergoing skull base surgery from 2000 to 2016 at a tertiary referral center was analyzed. One hundred sixty patients (81 males and 69 females) met inclusion criteria of the age of >70 years and endoscopic surgical approach. Data analyzed included demographics, pathology, and intraoperative and postoperative complications. Intraoperative complications included major bleeding, anesthesia, myocardial infarction, and other cardiac complications. Postoperative complications included cerebrospinal fluid (CSF) leak, postoperative bleed and infection, readmission, cranial nerve loss, pneumocephalus, stroke, early and late reoperation, flap failure, and death.

Results The mean age of the elderly cohort was 76.3 years. Forty-four patients (29.3%) had pituitary pathology, and 106 patients had nonpituitary pathology (70.7%). Thirty-two patients (21.3%) had malignant pathology, and 118 (78.7%) had benign pathology. The most common nonpituitary pathology was nonsellar benign tumor (42 out of 150, 28.0%), followed by malignant tumor (32 out of 150, 21.3%) and inflammatory process (18 out of 150, 12.0%). There was a statistical trend toward increased incidence of postoperative bleed in the pituitary pathology group (3 out of 44, 6.82%) compared with the nonpituitary group (1 out of 106, 0.94%) (p = 0.076). Other than postoperative bleed, there was no statistically significant difference in intraoperative or postoperative complications in pituitary versus nonpituitary or benign versus malignant pathology. Observed intraoperative complication rates in the nonpituitary pathology group were major bleeding (1 out of 106, 0.94%), anesthesia (1 out of 106, 0.94%), and other cardiac complications (1 out of 106, 0.94%). There were no observed intraoperative complications in the pituitary pathology group. Observed postoperative complication rates in the pituitary versus nonpituitary groups were CSF leak (0 out of 44, 0% vs. 1 out of 106, 0.94%), infection (0 out of 44, 0% vs. 2 out of 106, 1.9%), readmission (1 out of 44, 2.3% vs. 3 out of 106, 2.8%), stroke (0 out of 44, 0% vs. 1 out of 106, 0.94%), and early reoperation (0 out of 44, 0% vs. 2 out of 106, 1.9%). Intraoperative complications in the benign versus malignant pathology groups were major bleeding (1out of 118, 0.85% vs. 0/32, 0%), anesthesia (1 out of 118, 0.85% vs. 0/32, 0%), and other cardiac complications (1 out of 118, 0.85% vs. 0 out of 32, 0%). Postoperative complication rates in the benign versus malignant pathology groups were CSF leak (1 out of 118, 0.85% vs 0 out of 32, 0%), postoperative bleed (4 out of 118, 3.4% vs. 0 out of 32, 0%), infection (2 out of 118, 1.7% vs. 0 out of 32, 0%), readmission (4 out of 118, 3.4% vs. 0 out of 32, 0%), stroke (1 out of 118, 0.85% vs. 0 out of 32, 0%), and early reoperation (1 out of 118, 0.85% vs. 1 out of 32, 3.1%).

Conclusion Endoscopic resection of skull base lesions is a feasible and safe option in the elderly population. Pituitary versus nonpituitary or benign versus malignant underlying pathology is not associated with increased intraoperative or postoperative complications in this population.