Endoscopic Endonasal Skull Base Surgery in a 3-T Intraoperative MRI Suite: Complications and Postoperative Hospitalization

Introduction: Endoscopic endonasal skull base surgery provides advantages including improved visualization, no need for brain retraction, and low morbidity. Patients with complex skull base lesions were selected for surgery in a multidisciplinary setting that involved neurosurgery, otorhinolaryngology, and interventional radiology. Postoperative complications and the duration of hospitalization were registered.

Material and Methods: Surgery was performed in a dedicated operating suite with neuronavigation and 3 T intraoperative MRI. During the last year, we have operated on 22 patients in this setting with the following: nonproducing pituitary adenomas in 10 patients, clivus chordomas in 2, Wegener's granulomatosis in 2, recurrent CSF leak in 2, olfactory meningeoma in 1, schneiderian papilloma in 1, fibrous dysplasia in 1, petrous apex epidermoid in 1, meningoencephalocele in 1, and mucocele in 1.

Results: No postoperative hematomas or infections were recorded, and none of the patients experienced deterioration of vision. In 2 patients, there was a postoperative CSF leak (9%). One of these had another surgery, and the other resolved with lumbar drainage. Postoperative hospitalization varied between 0 and 18 days, with a mean of 4.2 days and a median of 3 days. The patients who had CSF leak were both hospitalized, 1 for 18 days and the other for 12. By excluding the 2 patients with complications, the mean postoperative hospitalization was reduced to 3.1 days and the median to 2.5 days.

Conclusion: Endoscopic endonasal surgery is a safe procedure for a variety of lesions at the skull base. The complications are mainly related to problems with watertight closure and skull base reconstruction, which constitute the main obstacles to further refinement of this surgery. The postoperative hospital stay is short, and the morbidity is low after endoscopic endonasal surgery.