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. 1996 Apr;6(2):113–118. doi: 10.1055/s-2008-1058652

Complications of Anterior Skull Base Surgery

Daniel G Deschler, Philip H Gutin, Adam N Mamelak, Michael W McDermott, Michael J Kaplan
PMCID: PMC1656572  PMID: 17170985

Abstract

The complications associated with anterior skull base surgery were reviewed in 49 consecutive patients treated between November 1986 and August 1993. All procedures involved a combined otolaryngologic and neurosurgical approach, and the senior otolaryngologist was the same. Fifty-two procedures were completed; 37 for malignant disease and 15 for benign disease. Twenty-one of the 52 procedures had postoperative complications, a 40% complication rate. One postoperative death occurred from a myocardial infarction, for a 2% mortality rate. Infections complications were the most common, occurring in 19% of cases. The one case of meningitis responded to antibiotic therapy, without neurologic sequelae. Seven cerebrospinal fluid leaks occurred (13%); five resolved with conservative management, and two required reoperation. There was no significant difference between complication rates for patients with previous craniotomy, radiation therapy, or chemotherany compared with those with no prior therapy (p > .05). More complications occurred in patients with malignant disease than in those with benign disease (46% vs 27%), but this was not statistically significant (p > .05). Anterior and anterolateral skull base resection as part of a multidisciplinary approach to diseases of this region may provide improved palliation and may offer possible improved survival with acceptable surgical mortality. Although only 6% of patients were left with permanent neurologic sequelse in this series, the risks of serious complications are considerable.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker S. R. Surgical reconstruction after extensive skull base surgery. Otolaryngol Clin North Am. 1984 Aug;17(3):591–599. [PubMed] [Google Scholar]
  2. Cheesman A. D., Lund V. J., Howard D. J. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses. Head Neck Surg. 1986 Jul-Aug;8(6):429–435. doi: 10.1002/hed.2890080606. [DOI] [PubMed] [Google Scholar]
  3. Deschler D. G., Kaplan M. J., Boles R. Treatment of large juvenile nasopharyngeal angiofibroma. Otolaryngol Head Neck Surg. 1992 Mar;106(3):278–284. doi: 10.1177/019459989210600315. [DOI] [PubMed] [Google Scholar]
  4. Johns M. E., Winn H. R., McLean W. C., Cantrell R. W. Pericranial flap for the closure of defects of craniofacial resection. Laryngoscope. 1981 Jun;91(6):952–959. doi: 10.1288/00005537-198106000-00013. [DOI] [PubMed] [Google Scholar]
  5. KETCHAM A. S., WILKINS R. H., VANBUREN J. M., SMITH R. R. A COMBINED INTRACRANIAL FACIAL APPROACH TO THE PARANASAL SINUSES. Am J Surg. 1963 Nov;106:698–703. doi: 10.1016/0002-9610(63)90387-8. [DOI] [PubMed] [Google Scholar]
  6. Ketcham A. S., Hoye R. C., Van Buren J. M., Johnson R. H., Smith R. R. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg. 1966 Oct;112(4):591–596. doi: 10.1016/0002-9610(66)90327-8. [DOI] [PubMed] [Google Scholar]
  7. Ketcham A. S., Van Buren J. M. Tumors of the paranasal sinuses: a therapeutic challenge. Am J Surg. 1985 Oct;150(4):406–413. doi: 10.1016/0002-9610(85)90145-x. [DOI] [PubMed] [Google Scholar]
  8. Lalwani A. K., Kaplan M. J., Gutin P. H. The transsphenoethmoid approach to the sphenoid sinus and clivus. Neurosurgery. 1992 Dec;31(6):1008–1014. doi: 10.1227/00006123-199212000-00004. [DOI] [PubMed] [Google Scholar]
  9. Levine P. A., Scher R. L., Jane J. A., Persing J. A., Newman S. A., Miller J., Cantrell R. W. The craniofacial resection--eleven-year experience at the University of Virginia: problems and solutions. Otolaryngol Head Neck Surg. 1989 Dec;101(6):665–669. doi: 10.1177/019459988910100609. [DOI] [PubMed] [Google Scholar]
  10. Maniglia A. J. Indications and techniques of midfacial degloving. A 15-year experience. Arch Otolaryngol Head Neck Surg. 1986 Jul;112(7):750–752. doi: 10.1001/archotol.1986.03780070062013. [DOI] [PubMed] [Google Scholar]
  11. Price J. C., Loury M., Carson B., Johns M. E. The pericranial flap for reconstruction of anterior skull base defects. Laryngoscope. 1988 Nov;98(11):1159–1164. doi: 10.1288/00005537-198811000-00002. [DOI] [PubMed] [Google Scholar]
  12. Richtsmeier W. J., Briggs R. J., Koch W. M., Eisele D. W., Loury M. C., Price J. C., Mattox D. E., Carson B. S. Complications and early outcome of anterior craniofacial resection. Arch Otolaryngol Head Neck Surg. 1992 Sep;118(9):913–917. doi: 10.1001/archotol.1992.01880090029010. [DOI] [PubMed] [Google Scholar]
  13. Schaefer S. D., Close L. G., Mickey B. E. Axial subcutaneous scalp flaps in the reconstruction of the anterior cranial fossa. Arch Otolaryngol Head Neck Surg. 1986 Jul;112(7):745–749. doi: 10.1001/archotol.1986.03780070057012. [DOI] [PubMed] [Google Scholar]
  14. Schramm V. L., Jr, Myers E. N., Maroon J. C. Anterior skull base surgery for benign and malignant disease. Laryngoscope. 1979 Jul;89(7 Pt 1):1077–1091. [PubMed] [Google Scholar]
  15. Schuller D. E., Goodman J. H., Miller C. A. Reconstruction of the skull base. Laryngoscope. 1984 Oct;94(10):1359–1364. doi: 10.1288/00005537-198410000-00018. [DOI] [PubMed] [Google Scholar]
  16. Sekhar L. N., Janecka I. P., Jones N. F. Subtemporal-infratemporal and basal subfrontal approach to extensive cranial base tumours. Acta Neurochir (Wien) 1988;92(1-4):83–92. doi: 10.1007/BF01401977. [DOI] [PubMed] [Google Scholar]
  17. Sekhar L. N., Nanda A., Sen C. N., Snyderman C. N., Janecka I. P. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg. 1992 Feb;76(2):198–206. doi: 10.3171/jns.1992.76.2.0198. [DOI] [PubMed] [Google Scholar]
  18. Shah J. P., Kraus D. H., Arbit E., Galicich J. H., Strong E. W. Craniofacial resection for tumors involving the anterior skull base. Otolaryngol Head Neck Surg. 1992 Apr;106(4):387–393. doi: 10.1177/019459989210600412. [DOI] [PubMed] [Google Scholar]
  19. Shah J. P., Sundaresan N., Galicich J., Strong E. W. Craniofacial resections for tumors involving the base of the skull. Am J Surg. 1987 Oct;154(4):352–358. doi: 10.1016/0002-9610(89)90003-2. [DOI] [PubMed] [Google Scholar]
  20. Sisson G. A., Sr, Toriumi D. M., Atiyah R. A. Paranasal sinus malignancy: a comprehensive update. Laryngoscope. 1989 Feb;99(2):143–150. doi: 10.1288/00005537-198902000-00005. [DOI] [PubMed] [Google Scholar]
  21. Snyderman C. H., Janecka I. P., Sekhar L. N., Sen C. N., Eibling D. E. Anterior cranial base reconstruction: role of galeal and pericranial flaps. Laryngoscope. 1990 Jun;100(6):607–614. doi: 10.1288/00005537-199006000-00011. [DOI] [PubMed] [Google Scholar]
  22. Stiernberg C. M., Bailey B. J., Weiner R. L., Calhoun K. H., Quinn F. B. Reconstruction of the anterior skull base following craniofacial resection. Arch Otolaryngol Head Neck Surg. 1987 Jul;113(7):710–712. doi: 10.1001/archotol.1987.01860070024009. [DOI] [PubMed] [Google Scholar]
  23. Sundaresan N., Shah J. P. Craniofacial resection for anterior skull base tumors. Head Neck Surg. 1988 Mar-Apr;10(4):219–224. doi: 10.1002/j.1930-2398.1988.tb00002.x. [DOI] [PubMed] [Google Scholar]
  24. Terz J. J., Young H. F., Lawrence W., Jr Combined craniofacial resection for locally advanced carcinoma of the head and neck II. Carcinoma of the paranasal sinuses. Am J Surg. 1980 Nov;140(5):618–624. doi: 10.1016/0002-9610(80)90043-4. [DOI] [PubMed] [Google Scholar]
  25. Van Tuyl R., Gussack G. S. Prognostic factors in craniofacial surgery. Laryngoscope. 1991 Mar;101(3):240–244. doi: 10.1288/00005537-199103000-00004. [DOI] [PubMed] [Google Scholar]

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