Complications of anterior craniofacial resection

Abstract

Abstract:Background. The complications associated with anterior craniofacial resections for benign and malignant tumors were reviewed in 104 patients treated between January 1981 and June 1996.Methods. Information regarding patient characteristics, histologic type, history of prior therapy, extent of the disease, extent of surgical procedure, and type of reconstruction were entered in a microcomputer database. To better understand and stage postoperative complications, we divided them into early (<14 days) and late (>14 days) according to the time of presentation, into major and minor depending on the morbidity potential of complication, and into local and systemic ones. Comparison between risk factors associated with complications was made using chisquare analysis with Yates' correction for continuity. Survival analysis was performed using the Kaplan-Meier product limit method.Results. There were 8 (7.6%) postoperative deaths, with only 1 occurring from systemic complications. Complications occurred in 53 (48.6%) patients. Local major complications occurred in 49 (45%) patients, local minor in 29 (26.6%), and systemic in 11 (10%). Early complications occurred in 40 (38.5%) patients and late complications in 13 (12.5%) patients. These complications developed during a period ranging from 1 day to 5 months. More than one complication occurred in a number of patients. Bacterial contamination leading to local septic complications was the principal cause of morbidity, accounting for 54.7% (29/53) of complications. Major complications included meningitis in 8 patients associated with cerebrospinal fluid leak in 7, cerebral abscess in 2, sepsis in 1, and subdural hemorrhage in 1, all of which resulted in death except for one case. The extent of the craniofacial resection (p = .011) was the most important factor associated with major complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (p = .048 and p = .032) and meningitis (p = .011).Conclusion. Contemporary surgical approaches and methods of reconstruction have enabled skull base surgeons to extend their cranial base resections and increase the 5-year survival rates of patients. Nevertheless, significant complications persist. Knowledge and high index of suspicion together with early recognition of these complications are essential for effective management of patients undergoing craniofacial resection. The factors related to major complications found in this study stressed the need to develop more effective methods to prevent contamination of intracranial structures.

Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery

“…Lumbar drainage has been advocated by cranial base surgeons to divert CSF to minimize the force required for frontal lobe retraction intraoperatively as well as to potentially decrease CSF leak rates postoperatively with prolonged usage by minimizing CSF egress through the defect, allowing it to heal. 2,5,6,17 However, the literature also cites numerous instances of TP complicating skull base surgery in which continuous lumbar drainage was used. 17,20 After a skull base defect is created, continuous lumbar drainage may promote the ingress of air through the skull base dural defect by creating a relatively lower pressure than the atmospheric pressure in the subarachnoid space.…”

One-Piece Modified Gasket Seal Technique

“…Failure to achieve these reconstructive goals can result in life-threatening complications such as CSF leak, meningitis, or tension pneumocephalus. 25,26 In 2008, Leng et al first described the gasket seal technique, a novel method to reconstruct skull base defects after endoscopic endonasal surgery. This technique, as originally described, involved the obliteration of intracranial dead space with autologous fat, followed by autologous fascia lata onlay graft countersunk into the skull base defect with a rigid buttress to form a watertight seal around the dura.…”

Reconstrução tridimensional da face nos tumores avançados com invasão da fossa craniana anterior

“…Entretanto, a reparação com retalhos livres reduz a morbidade cirúrgica das ressecções craniofaciais 6,[12][13][14] . A taxa de complicação de 58,6% é semelhante às encontradas na literatura, que variam de 16 a 64% 8,10,13,15 . As infecções locais ocorreram em 21,7% dos casos, sendo a complicação mais comum, talvez justificada pela inclusão em nossa avaliação de complicações locais como deiscências e infecções restritas, ou ao freqüente estado geral seriamente comprometido destes pacientes , seja pela gravidade da doença ou pelo baixo nível sócio-econômico e negligência nos cuidados com a saúde.…”

“…A possibilidade de fístula liquórica deve ser evitada a todo custo, sendo a complicação mais temível em cirurgias de base do crânio e uma das mais comuns 1,9,15 Os métodos empregados no reparo da duramáter foram os enxertos de fáscia lata ou gálea aponeurótica isolados ou em associação aos retalhos de pericrânio, técnicas bastante difundidas na literatura. 10,16,17 O volume dos retalhos livres preenche o espaço morto criado pela ressecção tumoral, estando em íntimo contato com o reparo da dura-máter, e contribui de forma importante para a prevenção de fístulas.…”