David L Choi1, Kesava Reddy2, Erik K Weitzel3, Brian W Rotenberg4, Allan Vescan5, Almunder Algird2, Doron D Sommer1. 1. 1 Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada. 2. 2 Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 3. 3 US Army Institute of Surgical Research, Ft Sam Houston, San Antonio, Texas. 4. 4 Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada. 5. 5 Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA. METHODS: A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. RESULTS: Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients' CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon's choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001). CONCLUSION: Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.
BACKGROUND: Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasalsaline in patients with OSA. METHODS: A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. RESULTS: Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients' CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon's choice to attribute the relationship between delaying the start of nasalsaline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001). CONCLUSION:Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.
Authors: Ryan A Rimmer; Chandala Chitguppi; Glen D'Souza; Marc R Rosen; Gurston G Nyquist; Elina Toskala; James J Evans; Christopher Farrell; Maurits Boon; Colin Huntley; Mindy R Rabinowitz Journal: Allergy Rhinol (Providence) Date: 2020-11-12
Authors: Erin K Reilly; Judd H Fastenberg; Mindy R Rabinowitz; Colin T Huntley; Maurits S Boon; Gregory A Epps; Swar Vimawala; Chandala Chitguppi; Jena Patel; Gurston G Nyquist; Marc R Rosen; James J Evans Journal: J Neurol Surg B Skull Base Date: 2020-08-05