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Surgical complications of endoscopic approach to skull base: analysis of 584 consecutive patients

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Abstract

Purpose

Endoscopic techniques have been widely applied for challenging cranial base surgeries in recent years. In this study, we evaluated the safety and efficacy of using the endoscopic endo-nasal route for various skull base pathologies in terms of postoperative complications.

Methods

A total of 584 consecutive patients who underwent endoscopic skull base surgery were studied. Peri- and post-operative complications and risk factors affecting the occurrence of these complications were evaluated.

Results

648 endoscopic skull base surgical procedures were performed on 584 patients (47.8% females and 52.2% males) with the mean age of 41.2 years. Pituitary adenoma (69.3%) was the most common pathology. Post-operative mortality was 2.0%. The rates of post-operative permanent neurological deficit (one case of 6th nerve injury, two 12th nerve injuries and one hemiparesis) and visual deterioration were 0.6% and 1.5%, respectively. Ten patients (1.7%) were complicated with meningitis and it was the cause of death in 3. Systemic complications not directly attributable to skull base surgical access occurred in 2% (11 patients) with 5 mortalities. The rate of intra-operative vascular injury was 1% and among them one patient died due to PCA injury. The most common post-operative complications were diabetes insipidus (12.5%), anterior pituitary dysfunction (10.6%) and CSF leak (3.6%), respectively. In general, reoperation, malignant lesions, and level IV of surgical complexity were associated with a higher incidence of complications.

Conclusion

Endoscopic endo-nasal approach can be a safe and less-morbid first-line treatment of patients with various skull base lesions.

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Availability of data and materials

The authors declare that the gathered data included and used for analysis outline are available in the manuscript.

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Acknowledgements

The authors wish to thank Dr. Zahid Hussain Khan for editing this manuscript.

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Authors and Affiliations

  1. Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Keshavarz Blvd, P. O. Box 1419733141, Tehran, Iran

    Mohammad Taghvaei, Sara Fallah, Mohammadreza Fathi & Mehdi Zeinalizadeh

  2. Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Taghvaei, Sara Fallah, Shokufeh Sadaghiani, Mohammadreza Fathi & Mehdi Zeinalizadeh

  3. Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Mousa Sadrhosseini & Azin Tabari

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  1. Mohammad Taghvaei
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  2. Sara Fallah
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  3. Shokufeh Sadaghiani
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  4. Seyed Mousa Sadrhosseini
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Correspondence to Mehdi Zeinalizadeh.

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Taghvaei, M., Fallah, S., Sadaghiani, S. et al. Surgical complications of endoscopic approach to skull base: analysis of 584 consecutive patients. Eur Arch Otorhinolaryngol 279, 3189–3199 (2022). https://doi.org/10.1007/s00405-022-07256-3

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