Anterior skull base surgery without prophylactic airway diversion procedures.
OBJECTIVE
Although anterior skull base surgery has become a relatively safe and effective procedure, postoperative complications remain a serious problem. One of the most devastating complications of anterior skull base procedures is tension pneumocephalus (TP). In order to prevent TP, authors have recommended the use of prophylactic airway diversion procedures, such as prolonged endotracheal intubation or prophylactic tracheostomy. However, these procedures may mask neurologic deterioration, delay treatment, and prolong rehabilitation. The purpose of this study was to determine the need for airway diversion procedures in anterior skull base surgery.


METHODS
Eighty-five patients underwent anterior skull base operations through the subcranial approach without prophylactic airway diversion. Sixty-four patients underwent resection of tumors, 12 patients underwent repair of cerebrospinal fluid leak, 6 patients underwent surgery due to anterior skull base fungal infections, and 3 patients underwent anterior skull base reconstruction procedures.


RESULTS
The complication rate of TP was 1.2% (1/85). This complication rate is similar to that previously reported for operations performed with airway diversion procedures.


CONCLUSIONS
Prophylactic airway diversion procedures are unnecessary in routine anterior skull base operations. Airway diversion should be indicated only when factors that might predispose the patient to risk of TP have been identified (ie, chronic cough or obstructive pulmonary diseases).
Gil
Ziv
Z
Skull-Base Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel.
Cohen
Jacob T
JT
Spektor
Sergei
S
Shlomi
Benjamin
B
Fliss
Dan M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011007:Pneumocephalus / Q000209:etiology* / Q000517:prevention & control*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D014139:Tracheostomy