title: Nasopharyngeal airway to prevent tension pneumocephalus after open resection of anterior skull base tumors.
abstract: We conducted a retrospective study to assess the efficacy of using a nasopharyngeal airway in lieu of a tracheotomy or prolonged intubation for the diversion of airflow to prevent tension pneumocephalus after an open resection of anterior skull base tumors. Our study population was made up of 120 patients-74 males and 46 females, aged 12 to 84 years (mean: 48.7)-who had undergone an anterior skull base resection with documented nasopharyngeal airway placement from 1996 through 2009. Our main outcome measure was the presence of tension pneumocephalus while controlling for the placement of a lumbar drain, the development of a cerebrospinal fluid (CSF) leak, and the type of reconstruction. All patients had been extubated on the day of surgery, and their nasopharyngeal airway had remained in place for 3 days. No documented complications of nasopharyngeal airway placement (e.g., nasal septum pressure necrosis or the displacement of tubes) had been documented. Tension pneumocephalus occurred in 3 patients (2.5%). A total of 33 patients (27.5%) received a lumbar drain, 14 (11.7%) experienced a CSF leak, and 5 (4.2%) had both. There was a statistically significant difference in the rate of tension pneumocephalus between patients who did and did not receive a lumbar drain placement (p = 0.02), between those who did and did not experience a CSF leak (p = 0.04), and between those who did and did not meet both criteria (p = 0.004). We conclude that resection of anterior skull base tumors does not necessitate a prophylactic tracheotomy or prolonged intubation and that the use of a nasopharyngeal airway to divert airflow is well tolerated and highly successful. Lumbar drainage, the development of a CSF leak, or both may increase the risk of tension pneumocephalus.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, 1904 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA. mspector@med.umich.edu.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.forename: Jon-Paul
authors.initials: JP
authors.lastname: Pepper
authors.forename: Stephen
authors.initials: S
authors.lastname: Sullivan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Marentette
authors.forename: Erin
authors.initials: E
authors.lastname: McKean
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000517:prevention & control; D002648:Child; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000601:surgery*; D011007:Pneumocephalus / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult