Evolution of an Endoscopic Skull Base Surgery Program in a Community Hospital Setting: The First 10 Years

Objective: Identify and describe trends regarding the outcomes of patients undergoing primary endoscopic skull base surgery within a community hospital setting.

Methods: A retrospective review of patients who underwent a primary endoscopic endonasal approach for resection of an anterior skull base lesion at a small, community hospital between January 2011 and January 2021. Patients were excluded if their resection was not primary, their procedure occurred outside of the designated timeline, or if their primary procedure was not related to excision of a neoplasm, such as spontaneous cerebrospinal fluid leak (CSF). 153 patients underwent a procedure within the study time. Of those, 103 patients met inclusion criteria.

Results: Of 103 patients, 54 patients were female with an average age of 54 years-old (18–88). Overall, 67% (69) of patients’ pathology reports were suggestive of pituitary adenoma or macroadenoma. Other common diagnoses included 8.7% (9) meningiomas and 5.8% (6) Rathke's cleft cyst.

From January 2011 through 2013, thirteen procedures were performed. The average length of stay was 4.31 (3–6) days. Zero CSF leaks, cases of meningitis, or mortalities occurred during this period. 100% of case pathology was pituitary adenoma/macroadenoma.

From January 2014 through 2017, thirty-four procedures were performed. The average length of stay was 5.15 (5–30) days. CSF leaks occurred in 17.7% of cases while meningitis occurred in 2.94% of cases. Zero mortalities occurred during this time period. 76.5% of case pathologies were for pituitary adenomas/macroadenomas.

From January 2018 to January 2021, a total of 56 procedures were performed. The average length of stay was 4.27 (1–15) days. 19.6% and 7.14% of patients experienced a CSF leak or meningitis, respectively. The mortality rate during this period was 1.8%. Pituitary adenomas/macroadenomas accounted for 60.7% case pathologies.

Conclusion: In the early years of our skull base practice in a community hospital, cases performed were selected to have a high likelihood of success with minimal risk of complications. With time, we gained experience and new personnel, expanded approaches were utilized more frequently. As a result, the practice evolved to treat increasingly diverse and complex cases, represented by the decreasing proportion of pituitary adenomas/macroadenomas. Rising rates for complications and mortality over time is likely attributable to increasing case complexity, but overall outcomes are comparable to those reported from high-volume, tertiary institutions. We demonstrate that endoscopic skull base surgery remains safe in the community hospital setting with acceptable risks for complications that can be appropriately managed ([Table 1]).

Table 1 Summary of outcomes from cases performed over 10 years

	2011–2013	2014–2017	2018–2021
No. procedures	13	34	56
% pituitary pathology	100	76.5	60.7
Mean length of stay (days)	4.31 (3–6)	5.15 (2–30)	4.27 (1–15)
CSF leak rate	0%	17.7%	19.6%
Meningitis rate	0%	2.94%	7.14%
Mortality rate	0%	0%	1.79%

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Artikel online veröffentlicht:
15. Februar 2022