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Perioperative management in endoscopic endonasal skull-base surgery: a survey of the North American Skull Base Society.

Abstract：

BACKGROUND:The objective of this work was to better understand variations in perioperative management in endoscopic endonasal skull-base surgery (EESBS) and to identify trends in management based upon the practice patterns of North American Skull Base Society (NASBS) members. METHODS:A 29-question survey evaluating perioperative EESBS management was sent to all NASBS members. Responses were analyzed with descriptive statistics. Subgroup analysis was performed based on participant demographics. A Bonferroni correction was performed and a p value <0.01 was considered statistically significant for subgroup analysis. RESULTS:Of 651 invitees, 116 responded (17.8%). Participants were primarily from the United States (81.0%), and practiced in academic centers (83.6%). The majority were neurosurgeons (55.2%) or rhinologists (27.6%). Most surgeons (83.6%) advocated use of preoperative intravenous antibiotics (96.6%) and image guidance in all cases (83.6%). Lumbar drains were not recommended for cases in which an intraoperative cerebrospinal fluid (CSF) leak was not anticipated (94.8%). Nasoseptal flaps (NSFs) were not recommended in cases without intraoperative CSF leak (84.5%), but were recommended in cases of high-flow intraoperative CSF leak (97.4%). While postoperative restrictions were highly variable, most providers recommended CSF leak precautions (89.7%), flying restrictions (94.0%), and driving restrictions (95.6%) regardless of intraoperative CSF leak status. Most experts also recommended that continuous positive airway pressure (CPAP) be avoided for at least 2 weeks when an intraoperative CSF leak is encountered (81.9%). CONCLUSION:Despite variation in perioperative management of EESBS patients, important trends were identified by this study. Further investigation is needed to standardize perioperative practice patterns in EESBS.

journal_name

Int Forum Allergy Rhinol

journal_title

International forum of allergy & rhinology

authors

Roxbury CR,Lobo BC,Kshettry VR,D'Anza B,Woodard TD,Recinos PF,Snyderman CH,Sindwani R

doi

10.1002/alr.22066

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

631-640

issue

eissn

2042-6976

issn

2042-6984

journal_volume

pub_type

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Perioperative management in endoscopic endonasal skull-base surgery: a survey of the North American Skull Base Society.