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Skull Base 2011; 21(1): 013-022
DOI: 10.1055/s-0030-1261265
ORIGINAL ARTICLE

© Thieme Medical Publishers

Endoscopic Transcranial and Intracranial Resection: Case Series and Design of a Perioperative Management Protocol

Evan R. Ransom1 , John Lee1 , 3 , John Y.K Lee2 , James N. Palmer1 , Alexander G. Chiu1
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
  • 2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
  • 3Department of Otolaryngology, Head and Neck Surgery, St. Michael's Hospital, University of Toronto Hospital System, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
21 June 2010 (online)

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ABSTRACT

Purely endoscopic resections of transcranial/intracranial pathology represent an exciting minimally invasive option for some patients. There is an abundance of literature on surgical techniques, though very little deals with perioperative management, which is critical for good outcomes. We present a detailed case review and a perioperative management protocol with specific reference to skull base and neuroanatomy. We performed a retrospective chart review and analysis of outcomes and complications by approach and design and prospective employment of a perioperative management protocol in a major tertiary care referral hospital. We included patients undergoing endoscopic skull base approaches by the two senior surgeons from September 2005 to April 2009, selecting of transcranial/intracranial cases for detailed review. Our main outcome measures included perioperative morbidity, mortality, and complications; degree of resection; recurrence rate; and survival. Fifteen patients met study criteria. No perioperative mortality occurred. There were two major and four minor complications. Mean follow-up was 15 months; 11/13 patients with malignancies had no evidence of disease. A perioperative management protocol was designed from these data and has resulted in decreased lumbar drainage and increased fluid/electrolyte monitoring. Endoscopic transcranial/intracranial anterior skull base surgery is both safe and effective when a complete understanding of the surgery and perioperative management is achieved.

KEYWORDS

Extended endonasal approach - endoscopic - anterior skull base - skull base neoplasm

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Alexander G ChiuM.D. 

Associate Professor, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania

3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19103

Email: alexander.chiu@uphs.upenn.edu