Comprehensive Postoperative Management After Endoscopic Skull Base Surgery

Duc A Tien; Janalee K Stokken; Pablo F Recinos; Troy D Woodard; Raj Sindwani

doi:10.1016/j.otc.2015.09.015

Comprehensive Postoperative Management After Endoscopic Skull Base Surgery

Otolaryngol Clin North Am. 2016 Feb;49(1):253-63. doi: 10.1016/j.otc.2015.09.015.

Authors

Duc A Tien¹, Janalee K Stokken², Pablo F Recinos³, Troy D Woodard³, Raj Sindwani⁴

Affiliations

¹ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
² Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
³ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: sindwar@ccf.org.

PMID: 26614842
DOI: 10.1016/j.otc.2015.09.015

Abstract

To maximize outcomes from endoscopic skull base surgery, careful early postoperative management is critically important. Standardized postoperative regimens are lacking. The type of reconstruction and presence and type of cerebrospinal fluid leak dictate management. If a leak is encountered intraoperatively, patients should avoid maneuvers that increase intracranial pressures for at least 1 month. Early postoperative care focuses on minimizing and managing nasal crusting. This article reviews the evidence in the literature on postoperative management, complications, and quality of life after surgery, and outlines our experience in the management of patients after endoscopic skull base surgery.

Keywords: CSF leak; Endoscopic skull base reconstruction; Endoscopic skull base surgery; Postoperative complications; Postoperative debridement; Postoperative infection; Postoperative management; Quality of life outcomes.

Publication types

Review

MeSH terms

Cerebrospinal Fluid Leak / etiology
Cerebrospinal Fluid Leak / therapy*
Endoscopy*
Humans
Magnetic Resonance Imaging
Neurosurgical Procedures*
Plastic Surgery Procedures*
Postoperative Complications / therapy*
Postoperative Period
Quality of Life
Skull Base / surgery
Skull Base Neoplasms / surgery
Surgical Flaps / blood supply