Complications of Endoscopic Anterior Craniofacial Resections: A 10-Year Experience

Educational Objective: The endoscopic resection of anterior ventral skull base lesions has been shown to be a safe, well-tolerated and effective surgical approach for select sinonasal and skull base tumors. The goal of this study was to compare short (<30 days from surgery) and long-term (>30 days) complication rates based on various treatment modalities.

Methods: A retrospective analysis of all endoscopic anterior craniofacial resections at a single tertiary referral institution from January 2010 to 2020 was conducted. A total of 50 patients met inclusion criteria.

Results: The majority of tumors excised were malignant (42/50, 84%) and the most common neoplasm encountered was esthesioneuroblastoma (17/50, 34%). Including the day of surgery, 44% (22/50) of patients remained in the hospital for 4 days or less. The 30-day readmission rate was 14% (7/50). The most common short-term complication was a postoperative cerebrospinal fluid (CSF) leak (6/50, 12%) followed by DVT or PE (4/50, 8%) and cerebritis (2/50, 4%). The most common long-term complication was a brain abscess or meningitis (4/50, 8%), followed by need for revision endonasal surgery (for sinusitis, dacrycystitis, or epistaxis, 3/50, 6%) and frontal lobe necrosis (1/50, 2%). Preoperative radiation or chemotherapy did not predispose to the development of short-term complications. However, postoperative radiation was significantly more likely to be associated with long-term complications. Interestingly, the mean time from surgery to long-term complication was 23 months. With respect to type of skull base reconstruction, the use of a nasoseptal flap did not protect against a postoperative CSF leak compared with an acellular dermal allograft alone. Finally, the presence of a postoperative CSF leak was not predictive of other short- or long-term complications.

Conclusion: The presence of a postoperative CSF leak following an endoscopic anterior craniofacial resection was not associated with preoperative systemic therapy or the type of skull base reconstruction. However, adjuvant radiation treatment was significantly associated with the development of a long-term postoperative complication.

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Publikationsverlauf

Artikel online veröffentlicht:
12. Februar 2021