Abstract
Objective This study was aimed to classify and study complications of surgery of the cranial
base, primarily from an otorhinolaryngology perspective.
Design This study was designed with consecutive cohort of skull base surgical cases.
Setting Tertiary referral academic center.
Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit,
from 2002 to 2015.
Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures,
categorized for complexity as per a unified system, are applicable to endoscopic and
open procedures. Complications were categorized as per the British Association of
Otolaryngologists coding of surgical complications. Complication classified as major
if life-threatening, causing permanent disability, or compromising the result of surgery.
Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment
follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external,
84) and 125 lateral skull-base procedures. Complication rates noted to increase in
both groups with increasing complexity of surgical intervention. Anterior skull-base
surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly
less surgical complications than lateral skull-base surgery (total complications,
33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic
and external approaches when compared across similar surgical complexity.
Conclusion Despite improvement in surgical and perioperative care, the overall major complication
rate in a contemporary otolaryngology led, primarily extradural, skull-base practice
is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard
method for categorization of surgical complexity and the grade of complications as
reported here is recommended.
Keywords
skull base - complications - skull-base surgery - mortality
