Complications in Salvage Surgery for Nasal and Paranasal Malignant Tumors Involving the Skull Base

Objective Nasal and paranasal malignant tumors invading the skull base are rare and poorly studied. We evaluated postoperative complications in patients undergoing salvage surgery for such tumors. Design Retrospective study. Setting Kobe University Hospital. Participants Among 48 patients who underwent surgery for tumors involving the skull base between 1993 and 2015, 21 patients had squamous cell carcinoma, 13 had olfactory neuroblastoma, 5 had adenocarcinoma, 2 had sarcoma, 2 had adenoid cystic carcinoma, and 1 each had malignant melanoma, poorly differentiated carcinoma, undifferentiated carcinoma, myoepithelial carcinoma, and malignant peripheral nerve sheath tumor. Prior to skull base surgery, radiotherapy, chemoradiotherapy (CRT), particle radiotherapy, chemotherapy, or surgery were applied in 3, 15, 4, 5, and 3 patients, respectively. Main Outcome Measures Main outcome measures were postoperative complications in patients who underwent skull base surgery after concomitant CRT and/or particle therapy. Results Major postoperative complications were observed in 14 surgical procedures (29%; 2 patients with cerebral herniation, 3 with cerebrospinal fluid leakages, 3 with meningitis, 1 with hydrocephalus, 6 with epidural abscesses, 2 with local infections, and 2 with partial flap necrosis). Four patients developed ≥2 complications. One patient died of postoperative lung infarction. Three (16.7%) of 18 patients without prior treatment and 9 (50%) of 18 patients who underwent preoperative radiotherapy/CRT had severe postoperative complications. Two (50%) of four patients treated with particle radiotherapy had postoperative complications. Conclusions CRT or particle radiotherapy were significantly associated with a high risk of severe postoperative complications after skull base surgery. Meticulous care should be taken in patients treated with radiotherapy/particle therapy prior to skull base surgery.

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Roles of skull base surgery and particle radiotherapy for orbital malignant tumors involving the skull base

Laryngoscope Investigative Otolaryngology ◽

10.1002/lio2.687 ◽

2021 ◽

Author(s):

Masanori Teshima ◽

Hirotaka Shinomiya ◽

Hidehito Kimura ◽

Kazunobu Hashikawa ◽

Naomi Kiyota ◽

...

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Malignant Tumors ◽

Particle Radiotherapy

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42 Controversies in Outcome Measures of Skull Base Surgery

Controversies in Skull Base Surgery ◽

10.1055/b-0039-171017 ◽

2019 ◽

Keyword(s):

Skull Base ◽

Outcome Measures ◽

Skull Base Surgery

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Utility of Early Postoperative Imaging after Combined Endoscopic and Open Ventral Skull Base Surgery

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4429 ◽

2017 ◽

Vol 31 (3) ◽

pp. 186-189 ◽

Cited By ~ 4

Author(s):

Zachary S. Mendelson ◽

Kristen A. Echanique ◽

Meghan M. Crippen ◽

Alejandro Vazquez ◽

James K. Liu ◽

...

Keyword(s):

Postoperative Complications ◽

Skull Base ◽

Clinical Symptoms ◽

Skull Base Surgery ◽

False Negative ◽

True Negative ◽

Endoscopic Endonasal ◽

Postoperative Imaging ◽

Significant Difference ◽

Ventral Skull Base

Purpose Immediate postoperative imaging is frequently obtained after combined skull base surgery (SBS) with endoscopic endonasal and open transcranial approaches. The importance of early postoperative imaging for detecting complications in these patients is still debatable. In this study, we investigated the clinical utility of early postoperative imaging after combined SBS for determination of postoperative complications. Methods A retrospective chart analysis of 21 cases of combined SBS between 2009 and 2015 was performed. Data on postoperative computed tomography (CT) and magnetic resonance imaging (MR), and the hospital course were collected. We separated interpretations of postoperative imaging into two groups: (1) when using the radiologist's interpretation alone, and (2) when using the surgeon's knowledge of the case in conjunction with imaging. Results Forty-two postoperative scans were obtained (21 CT, 21 MR) within 48 hours of surgery. There was a significant statistical difference between imaging interpretation by surgeons and radiologists for CT interpretation only. For CT interpretation the true positive (TP), false positive (FP), true negative (TN), and false negative (FN) rates for radiologists (TP, 0/21; FP, 6/21; TN, 11/21; FN, 4/21) slightly deviated from surgeons' interpretation (TP, 1/21 [p = 0.9999]; FP, 0/21 [p = 0.0207]; TN, 17/21 [p = 0.1000]; FN, 3/21 [p = 1.000]). Rates for MRI interpretation by both groups were nearly identical, with no significant difference found. Overall, four patients experienced seven postoperative complications, which led to a complication rate of 19.0% (4/21). The patients exhibited clinical symptoms in all instances of postoperative complications that required further intervention. Conclusion The benefit of early postoperative imaging to detect complications after combined SBS was limited. In this cohort of patients, positive imaging findings' effects on patient management were dictated by the presence of supporting clinical symptoms.

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A Systematic Review of Closure Techniques in Lateral Skull Base Tumor Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701673 ◽

2020 ◽

Author(s):

Alexander Malone ◽

Michael Randall ◽

K. Paul Boyev

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Skull Base ◽

Skull Base Surgery ◽

Wound Complication ◽

Wound Complications ◽

Skull Base Tumor ◽

Closure Technique ◽

Postoperative Wound ◽

Lateral Skull Base

Abstract Introduction Tumors of the lateral skull base often require collaboration between neurosurgeons and neurotologists for the surgical approach. The three main transosseous surgical approaches are retrosigmoid (RS), translabyrinthine (TL), and middle fossa (MF). The literature reflects a relative paucity regarding the various closure techniques for these approaches and the postoperative complications. We have performed a systematic review comparing closure techniques from each approach. Methods A systematic review was performed using Ovid MEDLINE (1990–2016) on closure technique and postoperative complications for patients undergoing lateral skull base surgery via the TL, RS, or MF approach. Studies were included if they contained at least 10 patients, described their closure technique, and provided data on postoperative complications. Results A total of 1,403 studies were reviewed. Of these, 53 studies met inclusion criteria yielding a total of 10,466 subjects in this analysis. The average rate of cerebrospinal fluid leak was 5.3% in the TL approach, 9% in the RS approach, and 6.2% in the MF approach. There was no significant effect of various closure techniques on postoperative wound complications in the MF approach. Multiple factors were identified which affected postoperative wound complication in the RS and TL approaches. Conclusion There are a plethora of closure techniques for lateral skull base surgery. Several techniques were identified in this review that may affect the postoperative wound complication rates in lateral skull base surgery.

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Prevention of postoperative complications in skull base surgery for nasal or paranasal sinus carcinoma invading the skull base

Journal of Clinical Neuroscience ◽

10.1054/jocn.2001.0881 ◽

2001 ◽

Vol 8 (4) ◽

pp. 67-70 ◽

Cited By ~ 5

Author(s):

Shigeru Nishizawa ◽

Naoki Yokota ◽

Tetsuo Yokoyama ◽

Hiroyuki Mukodaka ◽

Takahiro Watanabe ◽

...

Keyword(s):

Postoperative Complications ◽

Skull Base ◽

Paranasal Sinus ◽

Skull Base Surgery ◽

Paranasal Sinus Carcinoma

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Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

The Laryngoscope ◽

10.1002/lary.29485 ◽

2021 ◽

Author(s):

Roger K. Henry ◽

Russell A. Reeves ◽

P. Ashley Wackym ◽

Omar H. Ahmed ◽

Simon J. Hanft ◽

...

Keyword(s):

Postoperative Complications ◽

Skull Base ◽

Skull Base Surgery

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Anterior skull base surgery for malignant tumors: A multivariate analysis of 27 years of experience

Head & Neck ◽

10.1002/hed.10250 ◽

2003 ◽

Vol 25 (7) ◽

pp. 515-520 ◽

Cited By ~ 65

Author(s):

Brandon G. Bentz ◽

Mark H. Bilsky ◽

Jatin P. Shah ◽

Dennis Kraus

Keyword(s):

Multivariate Analysis ◽

Skull Base ◽

Skull Base Surgery ◽

Malignant Tumors ◽

Anterior Skull Base ◽

Years Of Experience

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Summary Skull base surgery for malignant tumors of the nasal cavity and paranasal sinuses

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.14.235 ◽

2004 ◽

Vol 14 (3) ◽

pp. 235-240

Author(s):

Toyoyuki Hanazawa ◽

Shigeki Gorai ◽

Toru Okawa ◽

Yoshitaka Okamoto ◽

Seiichiro Mine ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Paranasal Sinuses ◽

Skull Base Surgery ◽

Malignant Tumors

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Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery

Biomedicine Hub ◽

10.1159/000507750 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1-14

Author(s):

Kenya Kobayashi ◽

Fumihiko Matsumoto ◽

Yasuji Miyakita ◽

Masaki Arikawa ◽

Go Omura ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Blood Loss ◽

Skull Base ◽

Skull Base Surgery ◽

Length Of Hospital Stay ◽

Operation Time ◽

Postoperative Recovery ◽

Cranial Fossa ◽

Surgical Recovery

Background: To determine factors that delay surgical recovery and increase intraoperative hemorrhage in skull base surgery. Methods: Factors related to delayed postoperative recovery were retrospectively reviewed in 33 patients who underwent open skull base surgery. Early and late recovery phases were assessed as “days required to walk around the ward (DWW)” and “length of hospital stay (LHS),” respectively. Intraoperative blood loss was calculated every hour and analyzed in 4 steps, i.e., craniotomy and intracranial manipulation, cranial fossa osteotomy, extracranial osteotomy, and reconstruction. Results: More than 4,000 mL of blood loss (B = 2.7392, Exp[B] = 15.4744; 95% CI 1.1828–202.4417) and comorbidity (B = 2.3978, Exp[B]) = 10.9987; 95% CI 1.3534–98.3810) significantly prolonged the DWW; the occurrence of postoperative complications significantly delayed the LHS (p = 0.0316). Tumor invasion to the hard palate, the maxillary sinus, the pterygopalatine fossa, the base of the pterygoid process, the sphenoid sinus, the middle cranial fossa, and the cavernous sinus and a long operation time (>13 h) were associated with increased total hemorrhage. The optimal cut-off hemorrhage volume associated with total massive blood loss in craniotomy and intracranial manipulation (AUC = 0.8364), cranial fossa osteotomy (AUC = 0.8000), and extracranial osteotomy (AUC = 0.8545) was 1,111, 750, and 913 mL, respectively. Persistent infection (6%) and neuropsychiatric disorder (6%) are direct causes of delayed LHS. Conclusion: Blood loss, comorbidity, and postoperative complications were risk factors for delayed surgical recovery. Meticulous preoperative planning, intraoperative surefire hemostasis, and perioperative holistic management are prerequisites for safe skull base surgery.

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