Perioperative outcomes in patients undergoing the transglabellar/subcranial approach to the anterior skull base

Abstract

We analyzed the effect of predefined patient demographic, disease, and perioperative variables on the rate of complications in the perioperative period following subcranial surgery for anterior skull base lesion. A secondary goal of this study was to provide a benchmark rate of perioperative mortality and morbidity through comprehensive analysis of complications. Retrospective review of a consecutive series of patients (n = 164) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009 in a tertiary referral center. Main outcome measures were perioperative morbidity and mortality. No perioperative mortalities were observed over the period of consecutive review. The overall complication rate was 28.7%, with 30 (18%) patients experiencing major complication. Multivariate analysis revealed that the following variables were independent predictors of perioperative complication of any type: positive margins on final pathology, perioperative lumbar drain placement, and dural invasion. The subcranial approach provides excellent access to the anterior skull base with zero mortality and acceptable morbidity in comparison with other contemporary open surgical approaches. It should be considered a procedure with distinct advantages in terms of perioperative morbidity and mortality when selecting a therapeutic approach for patients with anterior skull base lesions.

Keywords: Subcranial; anterior skull base; postoperative complications; skull base neoplasms/surgery.

Figure 1

Pathology for all lesions (n = 164): 104 malignancies, 60 benign lesions. “Other carcinoma” includes mucoepidermoid carcinoma, basal cell carcinoma of the nasolacrimal duct, Papillary Schneiderian carcinoma, myoepithelial carcinoma, poorly differentiated carcinoma of lacrimal sac, and one metastatic Hurthle cell tumor. “Other benign” lesions include encephalocele, meningocele, arteriovenous malformation, ameloblastoma, cholesterol granuloma, schwannoma, null cell pituitary adenoma, chondromyxoid fibroma, and ossifying fibroma. SCC, squamous cell carcinoma; SNUC, sinonasal undifferentiated carcinoma.