title: Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients.
abstract: OBJECTIVE
  The development of endoscopic endonasal approaches, albeit in the early stages, represents part of the continuous evolution of skull base surgery. During this early period, it is important to determine the safety of these approaches by analyzing surgical complications to identify and eliminate their causes.
  
  
  METHODS
  The authors reviewed all perioperative complications associated with endoscopic endonasal skull base surgeries performed between July 1998 and June 2007 at the University of Pittsburgh Medical Center.
  
  
  RESULTS
  This study includes the data for the authors' first 800 patients, comprising 399 male (49.9%) and 401 female (50.1%) patients with a mean age of 49.21 years (range 3-96 years). Pituitary adenomas (39.1%) and meningiomas (11.8%) were the 2 most common pathologies. A postoperative CSF leak represented the most common complication, occurring in 15.9% of the patients. All patients with a postoperative CSF leak were successfully treated with a lumbar drain and/or another endoscopic approach, except for 1 patient who required a transcranial repair. The incidence of postoperative CSF leaks decreased significantly with the adoption of vascularized tissue for reconstruction of the skull base (< 6%). Transient neurological deficits occurred in 20 patients (2.5%) and permanent neurological deficits in 14 patients (1.8%). Intracranial infection and systemic complications were encountered and successfully treated in 13 (1.6%) and 17 (2.1%) patients, respectively. Seven patients died during the 30-day perioperative period, 6 of systemic illness and 1 of infection (overall mortality 0.9%).
  
  
  CONCLUSIONS
  Endoscopic endonasal skull base surgery provides a viable median corridor based on anatomical landmarks and is customized according to the specific pathological process. This corridor should be considered as the sole access or may be combined with traditional approaches. With the incremental acquisition of skills and experience, endoscopic endonasal approaches have an acceptable safety profile in select patients presenting with various skull base pathologies.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Ajith
authors.initials: A
authors.lastname: Thomas
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Adam
authors.initials: A
authors.lastname: Zanation
authors.forename: Bulent
authors.initials: B
authors.lastname: Duz
authors.forename: S Tonya
authors.initials: ST
authors.lastname: Stefko
authors.forename: Karin
authors.initials: K
authors.lastname: Byers
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000401:mortality; D009666:Nose / Q000601:surgery*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome