Abstract
Introduction
Surgery for skull base epidermoid cysts (SBECs) has several inherent risks including
aseptic meningitis and cerebrospinal fluid (CSF) malabsorption. Perioperative measures
to reduce the likelihood of such complications have not been evaluated, and this study
sought to compare outcomes before and after implementation of an institutional perioperative
protocol in the management of SBECs.
Methods
Review of a prospective database of surgically managed SBECs. Outcomes were compared
before (2003–2008) and after (2010–2021) implementation of a perioperative protocol
including intraoperative hyper-irrigation, prolonged course of postoperative steroids,
and aggressive management of CSF malabsorption.
Results
A total of 39 patients were included: 12 before and 27 after implementation of the
protocol. The groups were similar with respect to mean age (p = 0.99), gender (p = 0.29), surgical approach—most commonly retrosigmoid (p > 0.99)—and extent of resection—most commonly total or near total (p = 0.64). The post-protocol implementation group had a significantly lower rate of
CSF diversion (p = 0.04). The overall rates of hydrocephalus (7 vs. 30%), CSF leak (19 vs. 33%), bacterial
meningitis (15 vs. 33%), and mean length of stay (12 vs. 49 days) were lower in the
post-implementation group, although differences did not reach statistical significance.
Rates of aseptic meningitis and cranial nerve palsies were similar.
Conclusion
Our additional perioperative measures resulted in more favorable CSF dynamics with
reduced need for CSF diversion and secondary consequences such as wound leaks and
infective meningitis.
Keywords
epidermoid cysts - steroids - dexamethasone - irrigation - posterior fossa
