Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Keshavarz Blvd, P. O. Box 1419733141, Tehran, Iran.
Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Eur Arch Otorhinolaryngol. 2022 Jun;279(6):3189-3199. doi: 10.1007/s00405-022-07256-3. Epub 2022 Jan 31.
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.
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.
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.
Endoscopic endo-nasal approach can be a safe and less-morbid first-line treatment of patients with various skull base lesions.
近年来，内镜技术已广泛应用于颅底挑战性手术。本研究旨在评估经鼻内镜颅底手术在各种颅底病变中的安全性和有效性，特别是术后并发症方面。
回顾性分析 584 例接受内镜颅底手术的患者。评估围手术期并发症及影响并发症发生的危险因素。
584 例患者（47.8%为女性，52.2%为男性）共施行 648 例内镜颅底手术，平均年龄为 41.2 岁。最常见的病变是垂体腺瘤（69.3%）。术后死亡率为 2.0%。永久性神经功能缺损（1 例第 6 颅神经损伤，2 例第 12 颅神经损伤，1 例偏瘫）和视力恶化的发生率分别为 0.6%和 1.5%。10 例（1.7%）患者并发脑膜炎，其中 3 例因脑膜炎死亡。2%（11 例）患者出现与颅底手术入路无关的全身并发症，其中 5 例死亡。术中血管损伤的发生率为 1%，其中 1 例因 PCA 损伤死亡。最常见的术后并发症分别为尿崩症（12.5%）、垂体前叶功能减退（10.6%）和脑脊液漏（3.6%）。一般来说，再次手术、恶性病变和手术难度 IV 级与并发症发生率较高相关。
经鼻内镜入路是治疗各种颅底病变患者的安全、微创的一线治疗方法。
