Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurosurg. 2011 Jun;114(6):1544-68. doi: 10.3171/2010.10.JNS09406. Epub 2010 Dec 17.
The development of endoscopic endonasal approaches, albeit in the early stages, represents part of the continuous evolution of skull base surgery. During this early period, it is important to determine the safety of these approaches by analyzing surgical complications to identify and eliminate their causes.
The authors reviewed all perioperative complications associated with endoscopic endonasal skull base surgeries performed between July 1998 and June 2007 at the University of Pittsburgh Medical Center.
This study includes the data for the authors' first 800 patients, comprising 399 male (49.9%) and 401 female (50.1%) patients with a mean age of 49.21 years (range 3-96 years). Pituitary adenomas (39.1%) and meningiomas (11.8%) were the 2 most common pathologies. A postoperative CSF leak represented the most common complication, occurring in 15.9% of the patients. All patients with a postoperative CSF leak were successfully treated with a lumbar drain and/or another endoscopic approach, except for 1 patient who required a transcranial repair. The incidence of postoperative CSF leaks decreased significantly with the adoption of vascularized tissue for reconstruction of the skull base (< 6%). Transient neurological deficits occurred in 20 patients (2.5%) and permanent neurological deficits in 14 patients (1.8%). Intracranial infection and systemic complications were encountered and successfully treated in 13 (1.6%) and 17 (2.1%) patients, respectively. Seven patients died during the 30-day perioperative period, 6 of systemic illness and 1 of infection (overall mortality 0.9%).
Endoscopic endonasal skull base surgery provides a viable median corridor based on anatomical landmarks and is customized according to the specific pathological process. This corridor should be considered as the sole access or may be combined with traditional approaches. With the incremental acquisition of skills and experience, endoscopic endonasal approaches have an acceptable safety profile in select patients presenting with various skull base pathologies.
尽管内镜经鼻入路仍处于早期发展阶段，但它代表了颅底外科不断发展的一部分。在这一早期阶段，通过分析手术并发症来确定这些入路的安全性非常重要，以便识别并消除其原因。
作者回顾了 1998 年 7 月至 2007 年 6 月期间在匹兹堡大学医学中心进行的所有内镜经鼻颅底手术的围手术期并发症。
本研究包括作者前 800 例患者的数据，其中 399 例男性（49.9%）和 401 例女性（50.1%），平均年龄为 49.21 岁（范围 3-96 岁）。垂体腺瘤（39.1%）和脑膜瘤（11.8%）是最常见的两种病理类型。术后脑脊液漏是最常见的并发症，发生率为 15.9%。所有术后发生脑脊液漏的患者均通过腰椎引流和/或另一种内镜方法成功治疗，仅 1 例患者需要经颅修复。采用血管化组织重建颅底后，术后脑脊液漏的发生率显著下降（<6%）。20 例患者出现短暂性神经功能缺损（2.5%），14 例患者出现永久性神经功能缺损（1.8%）。颅内感染和全身并发症分别有 13 例（1.6%）和 17 例（2.1%）患者发生，并得到成功治疗。7 例患者在 30 天围手术期内死亡，6 例死于全身疾病，1 例死于感染（总死亡率 0.9%）。
内镜经鼻颅底手术提供了一条基于解剖标志的可行的中轴通道，并根据特定的病理过程进行了定制。这条通道可以被视为唯一的入路，也可以与传统方法相结合。随着技能和经验的逐步积累，内镜经鼻入路在选择的具有各种颅底病变的患者中具有可接受的安全性。
