Journal
EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
Volume 279, Issue 6, Pages 3189-3199Publisher
SPRINGER
DOI: 10.1007/s00405-022-07256-3
Keywords
Complication; Endo-nasal surgery; Endoscopic surgery; Skull base surgery
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This study evaluated the safety and efficacy of using the endoscopic endo-nasal route for various skull base pathologies and analyzed the postoperative complications. The results showed that the endoscopic endo-nasal approach can be a safe and less-morbid first-line treatment for patients with skull base lesions.
Purpose Endoscopic techniques have been widely applied for challenging cranial base surgeries in recent years. In this study, we evaluated the safety and efficacy of using the endoscopic endo-nasal route for various skull base pathologies in terms of postoperative complications. Methods A total of 584 consecutive patients who underwent endoscopic skull base surgery were studied. Peri- and post-operative complications and risk factors affecting the occurrence of these complications were evaluated. Results 648 endoscopic skull base surgical procedures were performed on 584 patients (47.8% females and 52.2% males) with the mean age of 41.2 years. Pituitary adenoma (69.3%) was the most common pathology. Post-operative mortality was 2.0%. The rates of post-operative permanent neurological deficit (one case of 6th nerve injury, two 12th nerve injuries and one hemiparesis) and visual deterioration were 0.6% and 1.5%, respectively. Ten patients (1.7%) were complicated with meningitis and it was the cause of death in 3. Systemic complications not directly attributable to skull base surgical access occurred in 2% (11 patients) with 5 mortalities. The rate of intra-operative vascular injury was 1% and among them one patient died due to PCA injury. The most common post-operative complications were diabetes insipidus (12.5%), anterior pituitary dysfunction (10.6%) and CSF leak (3.6%), respectively. In general, reoperation, malignant lesions, and level IV of surgical complexity were associated with a higher incidence of complications. Conclusion Endoscopic endo-nasal approach can be a safe and less-morbid first-line treatment of patients with various skull base lesions.
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