De Jesus Orlando
Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI.
Cureus. 2023 Dec 11;15(12):e50312. doi: 10.7759/cureus.50312. eCollection 2023 Dec.
Open skull base surgery carries the risk of significant complications. It is important to inform patients and family members clearly of the details of these complications. This study aimed to present the numerous complications encountered with open skull base surgery for brain tumors. This report analyzed the complications experienced by patients treated with open skull base surgery by a single skull base surgeon at a single tertiary center over 26 years.
A retrospective study was performed using the University of Puerto Rico Neurosurgery database to identify patients who were managed using open skull base procedures from 1995 to 2020. The neurosurgical database for each patient had been prospectively recorded. Patients with skull base tumors under the author's care during the study period were included in the investigation. Exclusions include patients with non-tumoral conditions and non-skull base tumors and those operated using a microscopic transsphenoidal route. Patients who experienced an intraoperative or postoperative complication within 30 days of the surgery were further analyzed.
In the cohort, 141 patients with brain tumors underwent open skull base surgery. The cohort had a median age of 48 (range 3-79). It consisted of 101 (71.6%) females and 40 (28.4%) males, with a female-to-male ratio of 2.5:1. The approach most frequently used was an orbitofrontal craniotomy (with or without zygomatic osteotomy) in 79 patients (56%). A petrosal approach was utilized in 26 patients (18%). Forty-six patients (33%) developed an intraoperative or postoperative complication. Twenty-four percent of the complications occurred in the 30-day postoperative period. Five patients had more than one complication. The median age of the patients who experienced a complication was 44.5 (range 22-79), with a female-to-male ratio similar to the entire cohort. Cranial nerve injury was the most frequent complication. Worsening or loss of vision in the affected eye occurred in 5.7% of the patients. A cerebrospinal fluid leak occurred in 2% of the patients. Six patients died, two of them after a massive myocardial infarction.
The results of this study showed that approximately one-third of the patients undergoing open skull base surgery can develop a complication. The most frequent complication was injury to a cranial nerve. A large number of complications occurred intraoperatively. The majority of the complications in patients with tumors in the posterior fossa were associated with injury to a cranial nerve. At the middle fossa, damage to the optic nerves is a noteworthy complication. Complications at the anterior fossa involved worsening of vision or myocardial infarction. Less aggressive surgery near the cavernous sinus and the petroclival region may reduce complications. Understanding the complications can help counsel patients and family members.
开放式颅底手术存在严重并发症的风险。向患者及其家属清楚告知这些并发症的细节非常重要。本研究旨在呈现脑肿瘤开放式颅底手术中遇到的众多并发症。本报告分析了在一家三级医疗中心，由一位颅底外科医生在26年期间对接受开放式颅底手术的患者所经历的并发症。
使用波多黎各大学神经外科数据库进行回顾性研究，以确定1995年至2020年期间接受开放式颅底手术治疗的患者。每位患者的神经外科数据库均已前瞻性记录。研究期间由作者护理的颅底肿瘤患者被纳入调查。排除标准包括患有非肿瘤性疾病和非颅底肿瘤的患者以及采用显微镜经蝶窦入路进行手术的患者。对在手术后30天内发生术中或术后并发症的患者进行进一步分析。
在该队列中，141例脑肿瘤患者接受了开放式颅底手术。该队列的中位年龄为48岁（范围3 - 79岁）。其中女性患者101例（71.6%），男性患者40例（28.4%），女性与男性比例为2.5:1。最常使用的手术入路是眶额开颅术（有或无颧骨截骨术），共79例患者（56%）。26例患者（18%）采用了岩骨入路。46例患者（33%）发生了术中或术后并发症。24%的并发症发生在术后30天内。5例患者出现了不止一种并发症。发生并发症的患者中位年龄为44.5岁（范围22 - 79岁），女性与男性比例与整个队列相似。颅神经损伤是最常见的并发症。患眼视力恶化或丧失的患者占5.7%。2%的患者发生了脑脊液漏。6例患者死亡，其中2例死于大面积心肌梗死。
本研究结果表明，接受开放式颅底手术的患者中约三分之一可能发生并发症。最常见的并发症是颅神经损伤。大量并发症发生在术中。后颅窝肿瘤患者的大多数并发症与颅神经损伤有关。在中颅窝，视神经损伤是一个值得注意的并发症。前颅窝的并发症包括视力恶化或心肌梗死。在海绵窦和岩斜区附近进行较保守的手术可能会减少并发症。了解这些并发症有助于为患者及其家属提供咨询。
