Perioperative Outcomes in Patients Undergoing the Transglabellar/Subcranial Approach to the Anterior Skull Base

ABSTRACT

We analyzed the effect of predefined patient demographic, disease, and perioperative variables on the rate of complications in the perioperative period following subcranial surgery for anterior skull base lesion. A secondary goal of this study was to provide a benchmark rate of perioperative mortality and morbidity through comprehensive analysis of complications. Retrospective review of a consecutive series of patients (n = 164) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009 in a tertiary referral center. Main outcome measures were perioperative morbidity and mortality. No perioperative mortalities were observed over the period of consecutive review. The overall complication rate was 28.7%, with 30 (18%) patients experiencing major complication. Multivariate analysis revealed that the following variables were independent predictors of perioperative complication of any type: positive margins on final pathology, perioperative lumbar drain placement, and dural invasion. The subcranial approach provides excellent access to the anterior skull base with zero mortality and acceptable morbidity in comparison with other contemporary open surgical approaches. It should be considered a procedure with distinct advantages in terms of perioperative morbidity and mortality when selecting a therapeutic approach for patients with anterior skull base lesions.

KEYWORDS

Subcranial - anterior skull base - skull base neoplasms/surgery - postoperative complications

REFERENCES

• 1 Smith R R, Klopp C T, Williams J M. Surgical treatment of cancer of the frontal sinus and adjacent areas.  Cancer. 1954;  7 991-994
• 2 Ketcham A S, Wilkins R H, Vanburen J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses.  Am J Surg. 1963;  106 698-703
• 3 Kellman R M, Marentette L J. The transglabellar/subcranial approach to the anterior skull base: a review of 72 cases.  Arch Otolaryngol Head Neck Surg. 2001;  127 687-690
• 4 Deschler D G, Gutin P H, Mamelak A N, McDermott M W, Kaplan M J. Complications of anterior skull base surgery.  Skull Base Surg. 1996;  6 113-118
• 5 Kraus D H, Shah J P, Arbit E, Galicich J H, Strong E W. Complications of craniofacial resection for tumors involving the anterior skull base.  Head Neck. 1994;  16 307-312
• 6 Ganly I, Patel S G, Singh B et al.. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.  Head Neck. 2005;  27 445-451
• 7 Dulgerov P, Jacobsen M S, Abdelkarim S A et al.. Nasal and paranasal sinus carcinoma: are we making progress?.  Cancer. 2001;  92 312-329
• 8 Donald P J. Complications in skull base surgery for malignancy.  Laryngoscope. 1999;  109 1959-1966
• 9 Gil Z, Patel S G, Bilsky M, Shah J P, Kraus D H. Complications after craniofacial resection for malignant tumors: are complication trends changing?.  Otolaryngol Head Neck Surg. 2009;  140 218-223
• 10 Dias F L, Sá G M, Kligerman J et al.. Complications of anterior craniofacial resection.  Head Neck. 1999;  21 12-20
• 11 Solero C L, DiMeco F, Sampath P et al.. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations.  Neurosurgery. 2000;  47 1296-1304 discussion 1304-1305
• 12 Ross D A, Marentette L J, Moore C E, Switz K L. Craniofacial resection: decreased complication rate with a modified subcranial approach.  Skull Base Surg. 1999;  9 95-100
• 13 Raveh J, Vuillemin T, Sutter F. Subcranial management of 395 combined frontobasal-midface fractures.  Arch Otolaryngol Head Neck Surg. 1988;  114 1114-1122
• 14 Shohet M R, Laedrach K, Guzman R, Raveh J. Advances in approaches to the cranial base: minimizing morbidity.  Facial Plast Surg. 2008;  24 129-134
• 15 Raveh J, Turk J B, Lädrach K et al.. Extended anterior subcranial approach for skull base tumors: long-term results.  J Neurosurg. 1995;  82 1002-1010
• 16 Patel S G, Singh B, Polluri A et al.. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study.  Cancer. 2003;  98 1179-1187
• 17 Lewis C M, Lin D T, Curry Jr W T, Barker II F G, Deschler D G. The use of nasopharyngeal airways for airway diversion in anterior craniofacial resection.  Am J Rhinol. 2008;  22 529-532
• 18 Fung K, Teknos T N, Vandenberg C D et al.. Prevention of wound complications following salvage laryngectomy using free vascularized tissue.  Head Neck. 2007;  29 425-430
• 19 Kraus D H, Gonen M, Mener D, Brown A E, Bilsky M H, Shah J P. A standardized regimen of antibiotics prevents infectious complications in skull base surgery.  Laryngoscope. 2005;  115 1347-1357
• 20 Carrau R L, Snyderman C, Janecka I P, Sekhar L, Sen C, D'Amico F. Antibiotic prophylaxis in cranial base surgery.  Head Neck. 1991;  13 311-317
• 21 Fliss D M, Abergel A, Cavel O, Margalit N, Gil Z. Combined subcranial approaches for excision of complex anterior skull base tumors.  Arch Otolaryngol Head Neck Surg. 2007;  133 888-896
• 22 Roland P S, Marple B F, Meyerhoff W L, Mickey B. Complications of lumbar spinal fluid drainage.  Otolaryngol Head Neck Surg. 1992;  107 564-569
• 23 Kryzanski J T, Annino Jr D J, Heilman C B. Complication avoidance in the treatment of malignant tumors of the skull base.  Neurosurg Focus. 2002;  12 e11
• 24 Bien A G, Bowdino B, Moore G, Leibrock L. Utilization of preoperative cerebrospinal fluid drain in skull base surgery.  Skull Base. 2007;  17 133-139
• 25 Myers L L, Sumer B D, Lowery J E, Truelson J M, Leach J L, Sinard R J. Changing patterns of tracheotomy use in anterior skull base surgery with free tissue reconstruction.  Laryngoscope. 2009;  119 453-458
• 26 Gil Z, Cohen J T, Spektor S, Shlomi B, Fliss D M. Anterior skull base surgery without prophylactic airway diversion procedures.  Otolaryngol Head Neck Surg. 2003;  128 681-685
• 27 Zimmer L A, Theodosopoulos P V. Anterior skull base surgery: open versus endoscopic.  Curr Opin Otolaryngol Head Neck Surg. 2009;  17 75-78
• 28 Eloy J A, Vivero R J, Hoang K et al.. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base.  Laryngoscope. 2009;  119 834-840
• 29 Hanna E, DeMonte F, Ibrahim S, Roberts D, Levine N, Kupferman M. Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results.  Arch Otolaryngol Head Neck Surg. 2009;  135 1219-1224