title: Endoscopic transnasal surgery as a replacement for maxillotomy techniques to approach the central skull base: fewer complications and more acceptable to patients?
abstract: Objectives To compare the complication rates of endoscopic transnasal and open maxillotomy approaches for the central skull base. Design Retrospective review. Setting Single-center study, London, United Kingdom. Participants From 1992 to 2012, 81 patients underwent surgery for skull base lesions, 59 by maxillotomy and 22 by endoscopy. Main Outcome Measures Total time of surgical anesthesia, blood loss, complications, duration of tracheal intubation, duration of hospital stay, myelopathy score, and mortality rate. Results The surgical time, blood loss, and duration of the postoperative intubation period were significantly less with endoscopy (p < 0.001). Requirements for intensive care, ward stay, and total hospital stay were also significantly less in the endoscopic group (p = 0.01, p < 0.001, and p < 0.001, respectively). The complication rate was lower with transnasal endoscopic surgery. Conclusion In patients for whom open maxillotomy or endoscopic surgery are both feasible, the preference should be to perform endoscopic surgery, with better visualization and fewer complications.
authors: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors: David
authors: D
authors: Choi
authors: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors: Ashok
authors: A
authors: Subramanian
authors: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors: Vivian
authors: V
authors: Elwell
authors: Department of ENT, The Royal National Throat Nose Ear Hospital, London, United Kingdom.
authors: Peter
authors: P
authors: Andrews
authors: Department of ENT, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom.
authors: David
authors: D
authors: Roberts
authors: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom ; Department of ENT, Guy's and St Thomas' Hospital NHS Trust, London, United Kingdom.
authors: Michael
authors: M
authors: Gleeson
keywords: complications; endoscopy; maxillotomy; skull base; surgery