Approaches to the skull base procedures, indications and complications

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Approaches to the skull baseprocedures,
indications and complications

• Raymund OConnor
• Department Surgery
• Supervisor Mr. M.G.J. OSullivan

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The skull base
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Aims

• To identify the pathology treated
• To define the approaches used
• To list the complications seen

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Methods

• Records of 89 patients treated with skull base
  procedures by a single surgeon between 1996 and
  2005.
• A database with
• Pathology
• Procedures
• Complications

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Results Pathology

• 60 tumours
• Mean age 46.5, FM1.61
• 36 meningiomas
• 24 other tumours
• 16 additional tumours managed conservatively

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Results Pathology

• 29 aneurysms
• Mean age 51, FM2.251
• 17 MCA (middle cerebral artery)
• Other ACoA (ant. communicating artery)
• PICA (post. inf. cerebellar artery)
• SCA (sup. cerebellar artery)
• Ophthalmic artery
• 13 managed without surgery

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Results Approaches

• Cranio-orbital 30 cases
• Far-lateral 11 cases
• Supra-orbital 8 cases
• Orbitozygomatic 7 cases
• Trans-petrosal 10 cases

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Approaches Supra-orbital (8/89)
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Approaches Cranio-orbital (30/89)
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Approaches Orbitozygomatic (7/89)
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Approaches Far-lateral (11/89)
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Complications

• 15 out of 89 operations
• Equates to 16.8 complication rate
• 3 cranio-orbital 10
• 3 far-lateral 27
• 2 supra-orbital 25
• 3 orbitozygomatic 42.8

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Complications

• Cranial nerves lesions
• CN VII
• CN V (maxillary
  division)
• CN III V (ophthalmic
  division)
• Bulbar Palsy
• Decreased vision 2
• Meningitis 2
• Stroke 1
• Haematoma1
• Bone flap infection1

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Complications (contd.)

• Diabetes insipidus1
• Pseudomeningocoele1
• Two patients died post-op
• MCA
• ACoA

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Conclusions

• Long operations
• Complex anatomy
• Complex lesions
• Technically difficult
• Low complication rate

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Questions?

• Thanks to Mr. Michael OSullivan,
• Consultant Neurosurgeon,
• CUH