Chaskes Mark B, Rabinowitz Mindy R
Department of Otolaryngology, Head and Neck Surgery Thomas Jefferson University Hospital Philadelphia USA.
World J Otorhinolaryngol Head Neck Surg. 2022 Mar 31;8(1):61-65. doi: 10.1016/j.wjorl.2021.07.002. eCollection 2022 Mar.
Patients with obstructive sleep apnea (OSA) are at increased risk of perioperative and postoperative morbidity. The use of continuous positive airway pressure (CPAP) in the perioperative period may be of potential benefit. However, among patients who have undergone endonasal skull base surgery, many surgeons avoid prompt re-initiation of CPAP therapy due to the theoretical increased risk of epistaxis, excessive dryness, pneumocephalus, repair migration, intracranial introduction of bacteria, and cerebrospinal fluid (CSF) leak. The objective of this article is to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endonasal skull base surgery.
This review combines the most recent literature as queried through PubMed regarding the safety of CPAP resumption following endonasal skull base surgery.
Recent surveys of skull base surgeons demonstrate little consensus regarding the post-operative management of OSA. Recent cadaveric studies suggest that approximately 85% of delivered CPAP pressures are transmitted to the sphenoid sinus. Further, at frequently prescribed CPAP pressure settings, common sellar reconstruction techniques maintain their integrity while preventing very little transmission of pressure into the sella. In small retrospective case series, patients with OSA who received CPAP immediately following transsphenoidal pituitary surgery had similar rates of surgical complications as OSA patients who did not receive CPAP in the immediate post-operative period. Concerns of re-initiating CPAP too early, such as the development of pneumocephalus, rarely develop.
There remains a paucity of objective data regarding when it is safe to resume CPAP following endonasal skull base surgery. Recent cadaveric studies and small retrospective case series suggest that it may be safe to resume CPAP earlier than is often practiced following endonasal skull base surgery.
阻塞性睡眠呼吸暂停（OSA）患者围手术期及术后发病风险增加。围手术期使用持续气道正压通气（CPAP）可能有益。然而，在接受鼻内镜颅底手术的患者中，由于理论上鼻出血、过度干燥、气颅、修复移位、细菌颅内引入及脑脊液（CSF）漏的风险增加，许多外科医生避免立即重新开始CPAP治疗。本文的目的是回顾关于鼻内镜颅底手术后何时安全恢复使用CPAP的最新文献。
本综述结合了通过PubMed检索到的关于鼻内镜颅底手术后恢复使用CPAP安全性的最新文献。
近期对颅底外科医生的调查显示，关于OSA的术后管理几乎没有共识。近期尸体研究表明，大约85%的CPAP输送压力会传递到蝶窦。此外，在常用的CPAP压力设置下，常见的鞍区重建技术能保持其完整性，同时很少有压力传递到鞍内。在小型回顾性病例系列中，经蝶垂体手术后立即接受CPAP治疗的OSA患者与术后未立即接受CPAP治疗的OSA患者手术并发症发生率相似。过早重新开始使用CPAP的担忧，如气颅的发生，很少出现。
关于鼻内镜颅底手术后何时安全恢复使用CPAP，目前仍然缺乏客观数据。近期尸体研究和小型回顾性病例系列表明，在鼻内镜颅底手术后比通常做法更早恢复使用CPAP可能是安全的。
