scholarly journals Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

2018 ◽  
Vol 80 (06) ◽  
pp. 586-592
Author(s):  
Uma Patnaik ◽  
Smriti Panda ◽  
Alok Thakar
Keyword(s):  
Skull Base ◽  
Surgical Complications ◽  
Skull Base Surgery ◽  
Major Complication ◽  
Anterior Skull Base ◽  
Complication Rates ◽  
Permanent Disability ◽  
Lateral Skull Base ◽  
Significant Difference ◽  
Surgical Complexity

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective. Design This study was designed with consecutive cohort of skull base surgical cases. Setting Tertiary referral academic center. Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015. Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery. Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity. Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.

scholarly journals A checklist for endonasal transsphenoidal anterior skull base surgery

2016 ◽  
Vol 124 (6) ◽  
pp. 1634-1639 ◽  
Author(s):  
Edward R. Laws ◽  
Judith M. Wong ◽  
Timothy R. Smith ◽  
Kenneth de los Reyes ◽  
Linda S. Aglio ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Fluid Management ◽  
Anterior Skull Base ◽  
Proper Function ◽  
Complication Rates ◽  
Arterial Access ◽  
Patient Disposition ◽  
Cranial Surgery ◽  
Duration Of Surgery

OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%–17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors’ institution has instituted a general preoperative “time-out” designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. CONCLUSIONS Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific checklist for endonasal transsphenoidal anterior skull base surgery was developed to help safeguard patients, improve outcomes, and enhance teambuilding.

Anatomical considerations of high jugular bulb in lateral skull base surgery

1997 ◽  
Vol 111 (4) ◽  
pp. 333-336 ◽  
Author(s):  
Asim Aslan ◽  
Maurizio Falcioni ◽  
Alessandra Russo ◽  
Giuseppe De Donato ◽  
Fatih Ridvan Balyan ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Bulb ◽  
Mastoid Process ◽  
High Jugular Bulb ◽  
Lateral Skull Base ◽  
Significant Difference ◽  
Temporal Bones

AbstractIn order to study high jugular bulb management in lateral skull base surgery, an anatomical study was conducted on 30 temporal bones by examining the relationship between the internal auditory canal (IAC) and the jugular bulb. The following parameters were measured: 1) Height of the jugular bulb (H) … distance between the level of the jugular bulb dome and the line passing through the confluence of the sigmoid sinus with the jugular bulb (SS-JB), 2) Mastoid length (ML) … distance between the mastoid process and middle cranial fossa dura, 3) Distance between the most inferior part of the porus acousticus and jugular bulb dome (A), 4) Distance between the porus acousticus and SS-JB (B). The jugular bulb was defined as high when it occupied more than two thirds of (B). The incidence of a high jugular bulb was 23 per cent in this study. When the jugular bulb was high, the mean (H) and (A) were 9.4 ± 1.9 mm and 2.7 ± 0.5 mm, respectively. (H) was higher on the right side than on the left side. No statistically significant difference was found between small and large mastoids (t-test: p>0.05). It was concluded that when a high jugular bulb was encountered during lateral skull base surgery, the jugular bulb position allows a very small working area inferior to the IAC. In these cases, a 3 or 4 mm depression of the jugular bulb is necessary in order to expose the lower cranial nerves. This can be accomplished by lowering the jugular bulb with the technique already described.

Increasing Safety in Lateral Skull Base Surgery by Navigation

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Rainer Schmelzeisen ◽  
Marc Metzger
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Lateral Skull Base

Complications of Endoscopic Pituitary and Anterior Skull Base Surgery: The Learning Curve

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Ameet Singh ◽  
Gurston Nyquist ◽  
Vijay Anand ◽  
Theodore Schwartz
Keyword(s):  
Learning Curve ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Anterior Skull Base

Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review

2021 ◽  
Author(s):  
Rajan P. Dang ◽  
Abhinav R. Ettyreddy ◽  
Zain Rizvi ◽  
Michelle Doering ◽  
Angela L. Mazul ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Free Flap ◽  
High Reliability ◽  
Anterior Skull Base ◽  
Microvascular Reconstruction ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Comprehensive Search

Abstract Objectives Given the limitations in the available literature, the precise indications, techniques, and outcomes of anterior skull base free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature and evaluate indications, methods, and complications for anterior skull base free flap reconstruction. Methods A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the anterior skull base. Articles were reviewed for inclusion based on relevance, with the primary outcome being surgical complications. Results After a comprehensive search, 406 articles were obtained and 16 articles were ultimately found to be relevant to this review—79 patients undergoing free flap reconstruction were identified. Overall complication rates were 17.7% (95% confidence interval [CI]: 16.6–33.1%) for major complications and 19.0% (95% CI: 17.8–35.5%) for minor complications. Conclusion Microvascular reconstruction of the anterior skull base is feasible with high reliability reported in the literature.

scholarly journals Levels of Evidence in Rhinology and Skull Base Surgery Research

2021 ◽  
pp. 019459982098713
Author(s):  
Jennifer A. Silver ◽  
Marco Mascarella ◽  
George Tali ◽  
Rickul Varshney ◽  
Marc A. Tewfik ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Absolute Number ◽  
High Quality ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
The Past ◽  
Significant Difference ◽  
Surgery Research ◽  
Based Medicine

Objective The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade. Study Design Review article. Setting We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals. Methods The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2. Results In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 ( P < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant ( P < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P = .077). Conclusion The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.

scholarly journals Preservation of nasal turbinates in endoscopic, anterior skull base surgery—yes, we can!

2021 ◽  
Author(s):  
Axel Wolf ◽  
Alexandros Andrianakis ◽  
Peter Valentin Tomazic ◽  
Michael Mokry ◽  
Georg Clarici ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Tumor Location ◽  
Anterior Skull Base ◽  
Tumor Diameter ◽  
Tumor Type ◽  
Preoperative Information ◽  
Medical University ◽  
Significant Factors

Abstract Objective To evaluate the frequency, type and indications of nasal turbinate (NT) resection during endoscopic, anterior skull base surgery and to analyze factors that may have an impact on the need of NT removal. Methods In this retrospective cohort study, 306 subjects (150 males and 156 females, mean age 55.4 ± 15.3 years) who underwent multidisciplinary, transnasal, endoscopic tumor surgery of the anterior skull base using 4-handed techniques between 2011 and 2019 at the Department of Otorhinolaryngology, Medical University of Graz, were included. Results In the majority of interventions (n = 281/306; 91.8%), all NT were preserved. Significant factors influencing the need of NT resections turned out to be type of endoscopic approach (p < 0.001; V = 0.304), sagittal (p = 0.003; d = 0.481) and transversal (p = 0.017; d = 0.533) tumor diameter, tumor type (p < 0.001; V = 0.355) and tumor location (p < 0.001; V = 0.324). Conclusions NT can be preserved in the majority of patients undergoing tumor resection in anterior, transnasal, skullbase surgery and routine resection of NT should be avoided. Variables that have an impact on the need of NT resections are types of endoscopic approaches, sagittal and transversal tumor extension and tumor type. These factors should be considered in planning of surgery and preoperative information of patients.

Automatic Registration for Navigation at the Anterior and Lateral Skull Base

2019 ◽  
Vol 128 (10) ◽  
pp. 894-902 ◽  
Author(s):  
Julia Kristin ◽  
Manuel Burggraf ◽  
Dirk Mucha ◽  
Christoph Malolepszy ◽  
Silvan Anderssohn ◽  
...  
Keyword(s):  
Skull Base ◽  
Navigation System ◽  
Automatic Registration ◽  
Total N ◽  
Electromagnetic Navigation ◽  
Registration Error ◽  
Target Registration Error ◽  
Lateral Skull Base ◽  
Significant Difference ◽  
Electromagnetic Navigation System

Objective: Navigation systems create a connection between imaging data and intraoperative situs, allowing the surgeon to consistently determine the location of instruments and patient anatomy during the surgical procedure. The best results regarding the target registration error (measurement uncertainty) are normally demonstrated using fiducials. This study aimed at investigating a new registration strategy for an electromagnetic navigation device. Methods: For evaluation of an electromagnetic navigation system and comparison of registration with screw markers and automatic registration, we are calculating the target registration error in the region of the paranasal sinuses/anterior and lateral skull base with the use of an electromagnetic navigation system and intraoperative digital volume tomography (cone-beam computed tomography). We carried out 10 registrations on a head model (total n = 150 measurements) and 10 registrations on 4 temporal bone specimens (total n = 160 measurements). Results: All in all, the automatic registration was easy to perform. For the models that were used, a significant difference between an automatic registration and the registration on fiducials was evident for just a limited number of screws. Furthermore, the observed differences varied in terms of the preferential registration procedure. Conclusion: The automatic registration strategy seems to be an alternative to the established methods in artificial and cadaver models of intraoperative scenarios. Using intraoperative imaging, there is an option to resort to this kind of registration as needed.

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