Endoscopic endonasal anterior skull base surgery: a systematic review of complications over the past 65 years.

Endoscopic endonasal anterior skull base surgery: a systematic review of complications over the past 65 years.

World Neurosurg. 2016 Mar 4;

Authors: Borg A, Kirkman MA, Choi D

Abstract
BACKGROUND: Endoscopic skull base surgery is becoming more popular as an approach to the anterior skull base for tumors and CSF fistulae. It offers the advantages of better cosmesis and improved quality of life after surgery. We reviewed the complication rates reported in the literature.
METHODS: A literature search was performed using the electronic database Ovid MEDLINE (1950 to 25(th) August 2015) using the search item "((Anterior) AND Skull base surgery) AND endoscopic".
RESULTS: We identified 82 relevant studies that included 7460 cases. An average overall complication rate of 17.1% (range 0 - 68.0%) and a mortality rate of 0.4% (0 -10.0%) was demonstrated in a total of 82 studies that included 7460 cases. The average CSF leak rate for all studies was 8.9% (0 - 40.0%) with meningiomas and clival lesions having the highest CSF leak rates. The most frequent benign pathology encountered was pituitary adenomas (n = 3720, 49.8% of all cases) and the most frequent malignant tumour was esthesioneuroblastoma (n = 120, 1.6% of all cases). Studies that included only CSF fistula repairs had a lower average total complication rate (12.9%) but a higher rate of meningitis when compared to studies that reported mixed pathology (2.4% vs. 1.3%). A trend towards a lower total complication rate with increasing study size was observed.
CONCLUSION: The endoscopic approach is an increasingly accepted technique for anterior skull base tumor surgery and is associated with acceptable complication rates. Increasing experience with this technique can decrease complication rates .

PMID: 26960277 [PubMed - as supplied by publisher]

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