J Neurol Surg B
DOI: 10.1055/s-0039-1694968
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Seizure Risk following Open and Expanded Endoscopic Endonasal Approaches for Intradural Skull Base Tumors

Ezequiel Goldschmidt
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Joseph D. Chabot
2  Department of Neurosciences, Centracare Clinic, St. Cloud Hospital, St. Cloud, Minneapolis, United States
,
Hanna Algattas
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Nicholas Khattar
3  Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, United States
,
Ana C. I. Nakassa
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Federico Angriman
4  Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
,
Carl H. Snyderman
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Eric W. Wang
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Juan C. Fernandez-Miranda
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
,
Paul A. Gardner
1  Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

10 May 2019

03 July 2019

Publication Date:
27 August 2019 (online)

Abstract

Objectives The incidence of seizures following a craniotomy for tumor removal varies between 15 and 20%. There has been increased use of endoscopic endonasal approaches (EEAs) for a variety of intracranial lesions due to its more direct approach to these pathologies. However, the incidence of postoperative seizures in this population is not well described.

Methods This is a single-center, retrospective review of consecutive patients undergoing EEA or open craniotomy for resection of a cranial base tumor between July 2007 and June 2014. Patients were included if they underwent an EEA for an intradural skull base lesion. Positive cases were defined by electroencephalograms and clinical findings. Patients who underwent a craniotomy to remove extra-axial skull base tumors were analyzed in the same fashion.

Results Of the 577 patients treated with an EEA for intradural tumors, 4 experienced a postoperative seizure (incidence 0.7%, 95% confidence interval [CI]: 0.002–0.02). Over the same period, 481 patients underwent a craniotomy for a skull base lesion of which 27 (5.3%, 95% CI: 0.03–0.08) experienced a seizure after surgery. The odds ratio for EEA was 0.13 (95% CI: 0.05–0.35). Both populations were different in terms of age, gender, tumor histology, and location.

Conclusion This study is the largest series looking at seizure incidence after EEA for intracranial lesions. Seizures are a rare occurrence following uncomplicated endonasal approaches. This must be tempered by selection bias, as there are inherent differences in which patients are treated with either approach that influence the likelihood of seizures.

Competing Interests

The authors have no personal or institutional interest with regard to the authorship and/or publication of this article.


Authors' Contribution

P.G., J.C., and E.G. were involved in the design and conception of this article. E.G. and H.A. performed the literature search. H.A., N.K., E.G., and A.N. performed the chart review. E.G. compiled the primary article. F.A. compiled the tables. P.G., J.C., E.G., C.S., J.F.M., and E.W. critically revised the article. All authors have approved the article as it is written.


Data Sharing

All data pertaining to this research article are included within the article as written.