Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice
24 June 2018
14 November 2018
26 December 2018 (online)
Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective.
Design This study was designed with consecutive cohort of skull base surgical cases.
Setting Tertiary referral academic center.
Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015.
Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery.
Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity.
Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.
- 1 Svider PF, Baredes S, Eloy JA. Pitfalls in sinus surgery: an overview of complications. Otolaryngol Clin North Am 2015; 48 (05) 725-737
- 2 Fu TS, Monteiro E, Muhanna N, Goldstein DP, de Almeida JR. Comparison of outcomes for open versus endoscopic approaches for olfactory neuroblastoma: A systematic review and individual participant data meta-analysis. Head Neck 2016; 38 (Suppl. 01) E2306-E2316
- 3 Nicolai P, Villaret AB, Bottazzoli M, Rossi E, Valsecchi MG. Ethmoid adenocarcinoma--from craniofacial to endoscopic resections: a single-institution experience over 25 years. Otolaryngol Head Neck Surg 2011; 145 (02) 330-337
- 4 Meccariello G, Deganello A, Choussy O. , et al. Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: a pooled-analysis of 1826 patients. Head Neck 2016; 38 (Suppl. 01) E2267-E2274
- 5 Cunningham III CD, Friedman RA, Brackmann DE, Hitselberger WE, Lin HW. Neurotologic skull base surgery in pediatric patients. Otol Neurotol 2005; 26 (02) 231-236
- 6 Patel SG, Singh B, Stambuk HE. , et al. Craniofacial surgery for esthesioneuroblastoma: report of an international collaborative study. J Neurol Surg B Skull Base 2012; 73 (03) 208-220
- 7 Miller JD, Taylor RJ, Ambrose EC, Laux JP, Ebert CS, Zanation AM. Complications of open approaches to the skull base in the endoscopic era. J Neurol Surg B Skull Base 2017; 78 (01) 11-17
- 8 Kassam AB, Prevedello DM, Carrau RL. , et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114 (06) 1544-1568
- 9 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117 (04) 699-705
- 10 Moffat DA. Recent Advances in Otolaryngology. Edinburgh: Churchill Livingstone; 1995: 27-40
- 11 Thakar A, Sikka K, Verma R, Preetam C. Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms. Eur Arch Otorhinolaryngol 2011; 268 (11) 1611-1616
- 12 Castelnuovo P, Dallan I, Battaglia P, Bignami M. Endoscopic endonasal skull base surgery: past, present and future. Eur Arch Otorhinolaryngol 2010; 267 (05) 649-663
- 13 Zanoletti E, Martini A, Emanuelli E, Mazzoni A. Lateral approaches to the skull base. Acta Otorhinolaryngol Ital 2012; 32 (05) 281-287
- 14 Kong J, Yang HY, Wang YF, Yang HJ, Shen SY, Wang F. Surgical management and follow-up of lateral skull base tumors: an 8-year review. Mol Clin Oncol 2017; 6 (02) 214-220
- 15 Sanna M, Mancini F, Saleh E, Piazza P, Khrais T, Russo A, Taibah A. Approaches to infratemporal fossa. In: Atlas of Microsurgery of the Lateral Skull Base, 2nd ed. Stuttgart: Thieme; 2008: 206-246
- 16 Wong GK, Poon WS, Lam MK. The impact of an armless frameless neuronavigation system on routine brain tumor surgery: a prospective analysis of 51 cases. Minim Invasive Neurosurg 2001; 44 (02) 99-103
- 17 Castelnuovo P, Pistochini A, Locatelli D. Different surgical approaches to the sellar region: focusing on the “two nostrils four hands technique”. Rhinology 2006; 44 (01) 2-7
- 18 Castelnuovo P, Battaglia P, Bignami M. , et al. Endoscopic transnasal resection of anterior skull base malignancy with a novel 3D endoscope and neuronavigation. Acta Otorhinolaryngol Ital 2012; 32 (03) 189-191
- 19 Tang H, Zhang H, Xie Q. , et al. Application of CUSA excel ultrasonic aspiration system in resection of skull base meningiomas. Chin J Cancer Res 2014; 26 (06) 653-657
- 20 Zoli M, Guaraldi F, Pasquini E, Frank G, Mazzatenta D. The endoscopic endonasal management of anterior skull base meningiomas. J Neurol Surg B Skull Base 2018; 79 (Suppl. 04) S300-S310