Early outcome and complications of the extended subcranial approach to the anterior skull base (original) (raw)
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Surgical technique for repair of complex anterior skull base defects
Surgical Neurology International, 2015
Background: Modern microsurgical techniques enable en bloc resection of complex skull base tumors. Anterior cranial base surgery, particularly, has been associated with a high rate of postoperative cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess, and pneumocephalus. We introduce simple modifications to already existing surgical strategies designed to minimize the incidence of postoperative CSF leak and associated morbidity and mortality. Methods: Medical records from 1995 to 2013 were reviewed in accordance with the Institutional Review Board. We identified 21 patients who underwent operations for repair of large anterior skull base defects following removal of sinonasal or intracranial pathology using standard craniofacial procedures. Patient charts were screened for CSF leak, meningitis, or intracranial abscess formation. Results: A total of 15 male and 6 female patients with an age range of 26-89 years were included. All patients were managed with the same operative technique for reconstruction of the frontal dura and skull base defect. Spinal drainage was used intraoperatively in all cases but the lumbar drain was removed at the end of each case in all patients. Only one patient required re-operation for repair of persistent CSF leak. None of the patients developed meningitis or intracranial abscess. There were no perioperative mortalities. Median follow-up was 10 months. Conclusion: The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons.
Seminars in Plastic Surgery
Traumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.
Complications of Skull Base Surgery: An Analysis of 30 Cases
Skull Base, 2008
Objectives: To evaluate the risk factors for perioperative complications among patients undergoing craniofacial resection for the treatment of skull base tumors. Design: Retrospective analysis. Participants: The study group comprised 29 patients with skull base tumors (22 malignant and 7 benign) who underwent 30 craniofacial resections at Hokkaido University Hospital between 1989 and 2006. Of these cases, 21 had undergone prior treatment by radiation (16 cases), surgery (7 cases), or chemotherapy (1 case). Moreover, 19 needed extended resection involving the dura (11 cases), brain (5 cases), orbit (12 cases), hard palate (5 cases), skin (3 cases), or cavernous sinus (2 cases). Main outcome measures: Perioperative complications and risk factor associated with their incidence. Results: Perioperative complications occurred in 12 patients (40%; 13 cases). There was a significant difference between complication rates for cases with and without prior therapy (52.4% vs. 11.1%). The complication rate for dural resection cases was 81.8%. There was a significant difference between complication rates for cases with and without dura resection. No postoperative mortality was reported. Conclusions: Craniofacial resection is a safe and effective treatment for skull base tumors. However, additional care is required in patients with extended resection (especially dural) and those who have undergone prior therapy.
Craniofacial Resection of Extensive Benign Lesions of the Anterior Skull Base
ANZ Journal of Surgery, 1987
The craniofacial resection operation was developed for the treatment of advanced nasal, paranasal and orbital malignancies. It has been refined in recent years, giving increased cure rates and better palliation when CUR is not possible. When used to mat extensive benign lesions involving the anterior skull base, this procedure allows more complete and safer resection with better access for repair and avoidance of major complications of brain damage, cerebrospinal fluid leak and haemorrhage. Resented here is a technique for craniofacial resection. The study demonstrates its effectiveness and low morbidity in treating 10 patients with extensive benign disease.
Craniofacial resection for lesions involving anterior base of skull
1996
Craniofacial resection represents a major advance in the surgical treatment of tumours of the paranasal sinuses. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumour resection. The development of computerised tomography has improved patient selection for surgery. The present study analyses results of craniofacial resection in 30 patients, 19 of whom had malignant tumours. Fourteen of these cases are disease-free after periods of 6 to 36 months. Eleven other patients had extensive benign lesions. A satisfactory reduction of proptosis and relief from other symptoms was obtained in all cases in the benign group. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumours of anterior skull base.
Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions
Skull base : official journal of North American Skull Base Society ... [et al.], 2008
Surgery is a cornerstone of treatment for a wide variety of neoplastic, congenital, traumatic, and inflammatory lesions involving the midline anterior skull base and may result in a significant anterior skull base defect requiring reconstruction. This study is a retrospective analysis of the reconstruction techniques and complications seen in a series of 58 consecutive patients with midline anterior skull base pathology treated with craniotomy or a craniofacial approach. The complication rates in this series are compared with other retrospective series and specific techniques that may reduce complications are then discussed. This is a retrospective analysis of 58 consecutive patients who had surgery for a midline anterior skull base lesion between January 1994 and July 2003. Data were collected regarding pathology, surgical approach, reconstruction technique, and complications. Twenty-nine patients underwent surgery for a meningioma (50%). The remainder had frontoethmoidal cancer, m...
Life-threatening anterior skull base injuries after endoscopic sinonasal surgery
Otorhinolaryngology-head and neck surgery, 2021
Objective: The purpose of our study was to ascertain the outcome of patients with iatrogenic anterior skull base injuries during functional endoscopic sinus surgery (FESS) and to identify factors regarding the patient, cerebrospinal fluid (CSF) leaks, and a treatment that may influence the results of the injury. Study Design and Setting: A retrospective analysis review of the patients in an otorhinolaryngology and neurosurgery tertiary referral center. Methods: 398 patients with medically refractory chronic rhinosinusitis who underwent FESS during a 2-year period were reviewed and analyzed. Additionally, we present two rare cases of iatrogenic skull base injuries during routine FESS with intracranial complications. Results: Complications occur mostly because of the close proximity of crucial anatomical structures such as the sinuses to the anterior cranial fossa, internal carotid arteries and orbit. The overall major complication rate was 2.8%; and the intracranial complication rate was 1.3%. The risk of an injury is related to the history of a previous surgery, the extent and severity of a disease, and anatomical variation. Intraoperative penetration of the skull base with laceration of the dura and the associated CSF leaks are not often immediately detected and thus cause life-threatening situations for patients. Conclusions: Although the improvement of FESS is notorious, concerning risks of complications still occur while carrying out FESS. The awareness of the location of skull base and orbit, together with early identification of anatomic landmarks during FESS, plays a pivotal role when it comes to avoiding complications. An exhaustive preoperative evaluation of the patient and a closer follow-up can help to further diminish negative outcomes.
Results and prognostic factors in skull base surgery
The American Journal of Surgery, 1994
The charts of 81 patients who underwent skull base surgery between 1982 and 1993 were reviewed retrospectively. Data relative to demographic aspects, clinical stage, previous treatment, surgical approach, type of reconstruction, histology, extent of disease, complications, and follow-up were analyzed. The eraniofacial approach for the anterior fossa was used in 53% of patients, the lateral skull base approach in 12%, and a combination of both in 17. Malignant tumors were diagnosed in 58 patients (72%), and histologically benign tumors in the remaining 23 (28%).