J Neurol Surg B Skull Base 2021; 82(04): 450-455
DOI: 10.1055/s-0040-1714097
Original Article

Averting Delayed Complications of Open Anterior Skull Base Surgery

1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Nir Livneh
1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Narin N. Carmel-Neiderman
1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Gilad Horowitz
1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Nevo Margalit
2   Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Dan M. Fliss
1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Avraham Abergel
1   Department of Otolaryngology—Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
› Author Affiliations

Abstract

Objective Despite its technical feasibility, anterior skull base surgery still carries the risk of severe postoperative complications, morbidity, and mortality. The reported rate of complications has diminished over the past two decades, but they continue to pose various challenges. This study aims to report late complications in a relatively large series of patients who underwent open anterior skull base surgery, and to propose methods for averting such complications.

Methods Retrospective chart review of all patients who underwent anterior open skull base surgery between 2000 and 2016 in a university-affiliated tertiary referral cancer center.

Results There were 301 operations, of which 198 (65.8%) were for benign disease and 103 (34.2%) were for malignant tumors. The male-to-female ratio was 1.4:1, and the mean age was 44.8 years. Delayed complications occurred in 85 patients (28.2%): 31 (10.3%) involved wounds, 18 (13.9%) involved the central nervous system, and 14 (4.6%) involved the orbit. Multivariate analysis found malignant pathology, intracranial extension, and previous radiochemotherapy as predictors for the development of a delayed complication. The patients who were operated in the later study period (after 2007) had lower rates of all three types of complications compared with the earlier study period.

Conclusion Delayed complications following skull base surgery are in decline. This is mainly due to the advancement in imaging studies, surgical techniques, development of sophisticated reconstructive procedures, and the cooperation of multidisciplinary teams. We attribute the reduction in our department to our revised treatment protocol which is presented herein, with emphasis on averting the occurrence of these complications.

Level of Evidence The level of evidence is 4.



Publication History

Received: 01 March 2020

Accepted: 03 May 2020

Article published online:
05 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Ketcham AS, Wilkins RH, Vanburen JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg 1963; 106 (05) 698-703
  • 2 Ketcham AS, Van Buren JM. Tumors of the paranasal sinuses: a therapeutic challenge. Am J Surg 1985; 150 (04) 406-413
  • 3 Dandy WE. Results following transcranial operative attack on orbital tumors. Arch Ophthalmol 1941; 25 (02) 191-216
  • 4 Ganly I, Patel SG, Singh B. et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (06) 445-451
  • 5 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
  • 6 Gray ST, Lin A, Curry WT. et al. Delayed complications after anterior craniofacial resection of malignant skull base tumors. J Neurol Surg B Skull Base 2014; 75 (02) 110-116
  • 7 O'Malley Jr BW, Janecka IP. Evolution of outcomes in cranial base surgery. Semin Surg Oncol 1995; 11 (03) 221-227
  • 8 Patel SG, Singh B, Polluri A. et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98 (06) 1179-1187
  • 9 Janecka IP, Sen C, Sekhar LN. et al. Cranial base surgery: results in 183 patients. Otolaryngol Head Neck Surg 1994; 110 (06) 539-546
  • 10 Fliss DM, Gil Z. Atlas of Surgical Approaches to Paranasal Sinuses and the Skull Base. Berlin, Germany: Springer; 2016
  • 11 Ringel B, Carmel-Neiderman NN, Ben-Ner D. et al. Outcomes of craniofacial open surgery in octogenarians. J Neurol Surg B Skull Base 2018; 79 (06) 515-521
  • 12 Kirsch CFE. Advances in magnetic resonance imaging of the skull base. Int Arch Otorhinolaryngol 2014; 18 (Suppl. 02) S127-S135
  • 13 Gil Z, Abergel A, Leider-Trejo L. et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections. Skull Base 2007; 17 (01) 25-37
  • 14 Amir A, Gatot A, Zucker G, Sagi A, Fliss DM. Harvesting large fascia lata sheaths: a rational approach. Skull Base Surg 2000; 10 (01) 29-34
  • 15 Gil Z, Fliss DM. Pericranial wrapping of the frontal bone after anterior skull base tumor resection. Plast Reconstr Surg 2005; 116 (02) 395-398 , discussion 399
  • 16 Gil Z, Cohen JT, Spektor S, Fliss DM. The role of hair shaving in skull base surgery. Otolaryngol Head Neck Surg 2003; 128 (01) 43-47
  • 17 Carrau RL, Snyderman C, Janecka IP, Sekhar L, Sen C, D'Amico F. Antibiotic prophylaxis in cranial base surgery. Head Neck 1991; 13 (04) 311-317
  • 18 Kraus DH, Gonen M, Mener D, Brown AE, Bilsky MH, Shah JP. A standardized regimen of antibiotics prevents infectious complications in skull base surgery. Laryngoscope 2005; 115 (08) 1347-1357
  • 19 Gil Z, Patel SG, Bilsky M, Shah JP, Kraus DH. Complications after craniofacial resection for malignant tumors: are complication trends changing?. Otolaryngol Head Neck Surg 2009; 140 (02) 218-223
  • 20 Ringel B, Carmel-Neiderman NN, Peri A. et al. Continuous lumbar drainage and the postoperative complication rate of open anterior skull base surgery. Laryngoscope 2018; 128 (12) 2702-2706
  • 21 Gil Z, Abergel A, Spektor S. et al. Quality of life following surgery for anterior skull base tumors. Arch Otolaryngol Head Neck Surg 2003; 129 (12) 1303-1309
  • 22 Abergel A, Cavel O, Margalit N, Fliss DM, Gil Z. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 2012; 138 (02) 142-147
  • 23 de Almeida JR, Vescan AD, Gullane PJ. et al. Development of a disease-specific quality-of-life questionnaire for anterior and central skull base pathology--the skull base inventory. Laryngoscope 2012; 122 (09) 1933-1942
  • 24 Abergel A, Fliss DM, Margalit N, Gil Z. A prospective evaluation of short-term health-related quality of life in patients undergoing anterior skull base surgery. Skull Base 2010; 20 (01) 27-33