Evolving concepts in the perioperative management of obstructive sleep apnea after endoscopic skull base surgery

2021 ◽  
Author(s):  
Mindy R. Rabinowitz ◽  
Mark Chaskes ◽  
Garret Choby ◽  
Eric W. Wang ◽  
Brian Thorp ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Perioperative Management ◽  
Skull Base Surgery ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

Management of Obstructive Sleep Apnea Following Endoscopic Skull Base Surgery

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Kevin Peng ◽  
Barbara Van de Wiele ◽  
Jeffrey Suh ◽  
Marvin Bergsneider ◽  
Marilene Wang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

scholarly journals Timing of Postoperative CSF Leak after Endoscopic Skull Base Surgery in Patients with Obstructive Sleep Apnea

2018 ◽  
Vol 80 (04) ◽  
pp. 392-398 ◽  
Author(s):  
Terence M. Zimmermann ◽  
Chris R. Marcellino ◽  
Garret W. Choby ◽  
Jamie J. Van Gompel ◽  
Erin K. O'Brien ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Small Sample ◽  
Csf Leak ◽  
Positive Pressure ◽  
High Risk Population ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

Background There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20). Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure.

scholarly journals Preoperative Screening for Obstructive Sleep Apnea Prior to Endoscopic Skull Base Surgery: A Survey of the North American Skull Base Society

2020 ◽  
Vol 11 ◽  
pp. 215265672096880
Author(s):  
Ryan A. Rimmer ◽  
Chandala Chitguppi ◽  
Glen D’Souza ◽  
Marc R. Rosen ◽  
Gurston G. Nyquist ◽  
...  
Keyword(s):  
Decision Making ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Preoperative Screening ◽  
Endoscopic Skull Base Surgery ◽  
The North ◽  
Obstructive Sleep ◽  
Screening Protocol

Background Obstructive sleep apnea (OSA) is a commonly seen comorbidity in patients undergoing endoscopic skull base surgery and its presence may influence perioperative decision-making. Current practice patterns for preoperative screening of OSA are poorly understood. Objective The objective of this study was to assess how endoscopic skull base surgeons screen for OSA, and how knowledge of OSA affects perioperative decision-making. Methods Seven question survey distributed to members of the North American Skull Base Society. Results Eighty-eight responses (10% response rate) were received. 60% of respondents were from academic centers who personally performed >50 cases per year. Most respondents noted that preoperative knowledge of OSA and its severity affected postoperative care and increased their concern for complications. Half of respondents noted that preoperative knowledge of OSA and its severity affects intraoperative skull base reconstruction decision-making. 70% of respondents did not have a preoperative OSA screening protocol. Body mass index and patient history were most frequently used by those who screened. Validated screening questionnaires were rarely used. 76% of respondents agreed or somewhat agreed that a preoperative polysomnogram should ideally be performed for patients with suspected OSA; however, 50% of respondents reported that <20% of their patients with suspected OSA are advised to obtain a preoperative polysomnogram. Conclusion This study reveals that most endoscopic skull base surgeons agree that OSA affects postoperative patient care, but only a minority have a preoperative screening protocol in place. Additional study is needed to assess the most appropriate screening methods and protocols for OSA patients undergoing endoscopic skull base surgery.

scholarly journals Postoperative Continuous Positive Airway Pressure Use and Nasal Saline Rinses After Endonasal Endoscopic Skull Base Surgery in Patients With Obstructive Sleep Apnea: A Practice Pattern Survey

2018 ◽  
Vol 33 (1) ◽  
pp. 51-55 ◽  
Author(s):  
David L. Choi ◽  
Kesava Reddy ◽  
Erik K. Weitzel ◽  
Brian W. Rotenberg ◽  
Allan Vescan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Standard Deviation ◽  
Skull Base ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Cpap Therapy ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

Background Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA. Methods A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. Results Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients’ CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon’s choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001). Conclusion Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.

Risk of Postoperative Complications in Patients with Obstructive Sleep Apnea following Skull Base Surgery

2018 ◽  
Vol 158 (6) ◽  
pp. 1140-1147 ◽  
Author(s):  
Phillip Huyett ◽  
Ryan J. Soose ◽  
Amy E. Schell ◽  
Juan C. Fernandez-Miranda ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Base Population ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Increased Risk

Objectives Obstructive sleep apnea (OSA) presents several challenges in skull base surgery, including increased intracranial pressure, worsened OSA with nasal packing, and avoidance of positive airway pressure (PAP) therapy postoperatively. The objective of this study was to examine the risk of postoperative complications in a skull base population with OSA in which PAP therapy is withheld. Study Design Retrospective cohort study. Setting Tertiary care hospital. Subjects and Methods Medical records of 414 adult patients undergoing anterior skull base procedures between January 1, 2014, and January 7, 2017, were retrospectively reviewed. Revision surgeries, skull base infections, sinus surgery, and orbital cases were excluded. Results Fifty-four (13.0%) patients with a diagnosis of OSA were identified. While the known patients with OSA were more likely to require postoperative supplemental oxygen (odds ratio [OR], 4.29; 95% confidence interval [CI], 2.38-7.75; P < .001), there was no increased risk of serious respiratory events or cerebrospinal fluid leak (CSF). To address the likely underdiagnosis of OSA in this cohort, subgroup analyses were performed of patients at high risk for OSA (body mass index >30 kg/m2 and hypertension) and demonstrated an increased risk of serious respiratory events (OR, 4.41; 95% CI, 1.24-15.7; P = .034) and CSF leak (13.6% vs 4.7%; P = .018). Conclusions Skull base patients with known OSA can be successfully managed with diligent care in the perioperative period when PAP therapy is withheld. However, OSA is likely underdiagnosed in the skull base population, and patients at high risk for undiagnosed OSA may be at the greatest risk for respiratory complications and CSF leak. Increased presurgical awareness and implementation of a perioperative management algorithm is needed.

scholarly journals Timing of Postoperative CSF Leak after Skull Base Surgery in Patients with Obstructive Sleep Apnea

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Terence Zimmermann ◽  
Chris Marcellino ◽  
Katie Van Abel ◽  
Jamie Van Gompel ◽  
Michael Link ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Obstructive Sleep

Obstructive Sleep Apnea

2018 ◽  
Author(s):  
Tomasz G. Rogula ◽  
Adriana Martin ◽  
Ivan Alberto Zepeda Mejia
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Management ◽  
Perioperative Management ◽  
Perioperative Period ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Preoperative Screening ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is highly prevalent in morbidly obese patients, although it is surprisingly underdiagnosed and undertreated. OSA can increase the risk of serious and life-threating complications in the perioperative period of bariatric surgery. Nevertheless, this potential risk can be minimized with adequate preoperative screening and perioperative management. The perioperative management of patients with OSA will affect the preparation for surgery, airway management, anesthetic selection, and monitoring. This chapter discusses and presents the best evidences available for the management of patients with OSA in order to decrease both the prevalence of undiagnosed patients and the morbidity associated with bariatric surgery.

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