Complications of Endoscopic Endonasal Skull Base Surgery

Abstract

Abstract Background Endoscopic endonasal skull base surgery (ESBS) has gained significant popularity over the last decade. However, there is a significant learning curve associated with these approaches and many potential complications, depending on the region and increasing with the complexity of the pathology. Methods This chapter is designed to review the complications associated with ESBS and review anatomic and technical details to prevent such complications. Results The internal carotid artery (ICA) provides one of the major limitations to lateral access for midline endonasal approaches. Avoidance and management of ICA injury remains critical for performing safe ESBS. In addition, the cranial nerves in the cavernous sinus and various cranial base foramina (optic canal, foramen rotundum and ovale, Dorello’s canal and the hypoglossal canal) create the lateral limits for ESBS. There are well defined anatomic landmarks for each of these, providing the keys to their safe identification and preservation. Cerebrospinal fluid leak remains the most common complication following ESBS, but has been dramatically decreased through the development and use of vascularized flaps and multilayered reconstruction. Conclusions ESBS is fraught with potential complications, but these can be largely avoided and the advantages of the approach preserved through detailed anatomic understanding and a healthy respect for the significant learning curve, both anatomic and technical.