title: Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.
abstract: Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA. A retrospective review was conducted from a surgical outcomes database. Electronic medical records were reviewed, with an emphasis on diagnosis of OSA and documented symptomatic pneumocephalus. A total of 324 patients underwent 349 TSS for sellar mass resection. The average body mass index of the study cohort was 32.5kg/m(2). Sixty-nine patients (21%) had documented OSA. Only 25 out of 69 (36%) had a documented post-operative CPAP plan. Out of all 349 procedures, there were two incidents of pneumocephalus diagnosed. Neither of the patients had pre-existing OSA. One in five patients in our study had pre-existing OSA. Most patients returned to CPAP use within several weeks of TSS for resection of a sellar mass. Neither of the patients with pneumocephalus had pre-existing OSA and none of the patients with early re-initiation of CPAP developed this complication. This study provides preliminary evidence that resuming CPAP early in the post-operative period might be less dangerous than previously assumed.
authors.affiliation: Vanderbilt University School of Medicine, T4224 Medical Center North, Nashville, TN 37212, USA. Electronic address: gabrielle.a.white-dzuro@vanderbilt.edu.
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: White-Dzuro
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Maynard
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Weaver
authors.affiliation: Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Russell
authors.affiliation: Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Clavenna
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Lola B
authors.initials: LB
authors.lastname: Chambless
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011007:Pneumocephalus / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013101:Sphenoid Sinus / Q000601:surgery*
keywords: Endoscopic; Sellar mass; Skull base surgery; Transsphenoidal