Skip to main content
SpringerLink
Log in

Should we take precautions to avoid respiratory compromise while delaying CPAP resumption following transsfenoidal surgery? An alternative approach in a patient with severe obstructive sleep apnea: case report

  • Case Report - Pituitaries
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

We describe a patient with severe obstructive sleep apnea scheduled for transsfenoidal surgery. Early postoperative use of continuous positive airway pressure (CPAP) was considered unsafe because increased risk of intracranial complications.

Methods

Aiming to bypass the upper airway obstruction and thus avoid CPAP, a 6-mm nasopharyngeal airway was introduced by the surgical team under endoscopic vision. In the postoperative period and during follow-up, patient and his family did not complain about apnea/hypopnea episodes and nasopharyngeal airway was tolerated comfortably.

Conclusion

We recommend this technique as an alternative in obstructive sleep apnea patients undergoing transsfenoidal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gross JB, Bachenberg KL, Benumof JL et al (2006) American Society of Anesthesiologists practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104:1081–1093

    Article  Google Scholar 

  2. Sawka AM, Aniszewski JP, Young WF Jr, Nippoldt TB, Yanez P, Ebersold MJ (1998) Tension pneumocranium, a rare complication of trans-sphenoidal pituitary surgery: Mayo Clinic experience 1976–1998. J Clin Endocrinol Metab 84:4731–4734. https://doi.org/10.1210/jcem.84.12.6197

    Article  Google Scholar 

  3. Kopelovich JC, de la Garza GO, Greenlee JD, Graham SM, Udeh CI, O’Brien EK (2012) Pneumocephalus with BiPAP use after transsphenoidal surgery. J Clin Anesth 24:415–418. https://doi.org/10.1016/j.jclinane.2011.12.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kuzniar TJ, Gruber B, Mutlu GM (2005) Cerebrospinal fluid leak and meningitis associated with nasal continuous positive airway pressure therapy. Chest 128:1882–1884. https://doi.org/10.1378/chest.128.3.1882

    Article  PubMed  Google Scholar 

  5. Yared J, El Annan J (2010) Cerebrospinal fluid leak associated with nasal continuous positive airway pressure treatment for obstructive sleep apnoea. BMJ Case Rep 2010:201. https://doi.org/10.1136/bcr.01.2010.2659

    Article  Google Scholar 

  6. Zlotnik D, Taylor G, Simmoneau A, Viot-Blanc V, Devys JM (2014) Two cases of pneumocephalus following noninvasive continuous positive airway ventilation after transsphenoidal neurosurgery. Ann Fr Anesth Reanim 33:275–278. https://doi.org/10.1016/j.annfar.2014.03.001

    Article  CAS  PubMed  Google Scholar 

  7. Jarjour NN, Wilson P (1989) Pneumocephalus associated with nasal continuous positive airway pressure in a patient with sleep apnea syndrome. Chest 96:1425–1426. https://doi.org/10.1378/chest.96.6.1425

    Article  CAS  PubMed  Google Scholar 

  8. White-Dzuro GA, Maynard K, Zuckerman SL, Russell PT, Clavenna MJ, Chambless LB (2016) Risk of postoperative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery. J Clin Neurosci 29:25–28. https://doi.org/10.1016/j.jocn.2016.01.012

    Article  PubMed  Google Scholar 

  9. D’Ignazio T, Francispillai M, Giroux M, Albert M (2021) Delayed CPAP-induced pneumocephalus and meningitis posttranssphenoidal surgery. Case Reports in Critical Care Article ID: 8855879. https://doi.org/10.1155/2021/8855879

  10. Gravbrot N, Jahnke H, White WL, Little AS (2020) Resumption of positive-pressure ventilation devices for obstructive sleep apnea following transsphenoidal surgery: an institutional experience of a surgical cohort. J Neurol Surg B Skull Base 81:237–243. https://doi.org/10.1055/s-0039-1688795

    Article  PubMed  Google Scholar 

  11. Gupta RM, Parvizi J, Hanssen AD, Gay PC (2001) Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76:897–905. https://doi.org/10.4065/76.9.897

    Article  CAS  PubMed  Google Scholar 

  12. Chung SA, Yuan H, Chung F (2008) A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg 107:1543–1563. https://doi.org/10.1213/ane.0b013e318187c83a

    Article  PubMed  Google Scholar 

  13. Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F (2009) Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anaesth 56:819–828. https://doi.org/10.1007/s12630-009-9190-y

    Article  PubMed  Google Scholar 

  14. Vasu TS, Grewal R, Doghramji K (2012) Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 8:199–207. https://doi.org/10.5664/jcsm.1784

    Article  PubMed  PubMed Central  Google Scholar 

  15. Young ML, Hanson CW (1993) An alternative to tracheostomy following transsphenoidal hypophysectomy in a patient with acromegaly and sleep apnea. Anesth Analg 76:446–449

    CAS  PubMed  Google Scholar 

  16. Ahmed J, Marucci D, Cochrane L, Heywood RL, Wyatt ME, Leighton SE (2008) The role of the nasopharyngeal airway for obstructive sleep apnea in syndromic craniosynostosis. J Craniofac Surg 19:659–663. https://doi.org/10.1097/SCS.0b013e31816ae386

    Article  PubMed  Google Scholar 

  17. Nahmias JS, Karetzku MS (1988) Treatment of the obstructive sleep apnea syndrome using a nasopharyngeal tube. Chest 94:1142–1147

    Article  CAS  Google Scholar 

  18. Rahimi E, Mariappan R, Tharmaradinam S, Manninen P, Venkatraghavan L (2014) Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: our institutional experience. J Anaesthesiol Clin Pharmacol 30:351–354. https://doi.org/10.4103/0970-9185.137266

    Article  PubMed  PubMed Central  Google Scholar 

  19. Piper J, Dirks B, Traynelis V, VanGilder J (1995) Perioperative management and surgical outcome of the acromegalic patient with sleep apnea. Neurosurgery 36:70–75. https://doi.org/10.1227/00006123-19950100000009

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anesthesiology, LIV Hospital Vadistanbul, Istanbul, Turkey

    Yılmaz Yenigün, Kamil Mehmet Tuğrul & Uğur Özbek

  2. Anesthesiology and Reanimation, Istinye University, Istanbul, Turkey

    Anıl Özonur

  3. Neurosurgery, Istinye University, Istanbul, Turkey

    Nurperi Gazioğlu

Authors
  1. Yılmaz Yenigün
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anıl Özonur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kamil Mehmet Tuğrul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Uğur Özbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nurperi Gazioğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yılmaz Yenigün.

Ethics declarations

Ethics statement

The present case report includes no experimental treatment and all information is de-identified. It is in accordance with the ethical standards of the institutional ethics committee and COPE guidelines and complies with the CARE statement.

Consent for publication

The participant has consented to participate and submission of the case report to the journal.

Conflict of interest

The authors declare no competing interests.

Additional information

Comments

The authors describe the use of a nasopharyngeal airway following transsphenoidal surgery in a patient with obstructive sleep apnea. This is a practical solution to a problem that is more common with the prevalence of obesity worldwide and the use of CPAP by many patients. The case is well described and illustrated, and I think it is an interesting solution. The patient appeared to tolerate the airway well and avoid the early use of CPAP. One might question if the device would help the breathing in patients with predominately oral pharynx restriction of breathing. I have personally used sphenoid fat packing in patients dependent upon CPAP for many years as a solution, and we let the patients use CPAP immediately, with no complications. However, this current technical solution avoids the need for fat graft harvesting.

More experience than one patient would be of value here.

William T. Couldwell.

UT, USA.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pituitaries

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yenigün, Y., Özonur, A., Tuğrul, K.M. et al. Should we take precautions to avoid respiratory compromise while delaying CPAP resumption following transsfenoidal surgery? An alternative approach in a patient with severe obstructive sleep apnea: case report. Acta Neurochir 164, 1615–1618 (2022). https://doi.org/10.1007/s00701-022-05213-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05213-x

Keywords

Search

Navigation