Vascular Complications of Endoscopic Cranial Base Surgery

Introduction: Tumors of the ventral skull base and brain can now be resected endoscopically. One concern regarding the endoscopic approach is the ability to deal with vascular injuries. We reviewed our experience with over 400 endoscopic skull base surgeries to identify vascular injuries and assess the causes, management, and morbidity.

Methods: Patients undergoing endoscopic cranial base surgery at the University of Pittsburgh Medical Center from 1998 to 2005 were reviewed retrospectively to identify major vascular complications. Complications were considered major if they were considered life-threatening or resulted in a neurological deficit. These were categorized as preoperative, intraoperative, and postoperative.

Results: In over 400 endoscopic skull base procedures, only 7 major vascular complications occurred. Three of these were related to preoperative angiography and embolization and 1 occurred postoperatively and was not directly related to the tumor dissection. Of the 3 intraoperative vascular complications, injured vessels included the internal maxillary artery, the internal carotid artery, and a P1 perforator. Neurological deficits resulted in 2 of these patients.

Conclusions: Major vascular complications are rare occurrences with endoscopic surgery of the ventral skull base and can be prevented with careful adherence to proper dissection techniques and identification of anatomical landmarks. Major vascular injuries can be effectively controlled in the operative setting using endoscopic techniques.