Anterior skull base surgery without prophylactic airway diversion procedures

Although craniofacial resection has become a relatively safe and effective procedure, postoperative complications remain a serious problem. A most devastating complication of anterior skull base procedures is pneumocephalus. For the prevention of this serious complication, many authors have recommended prophylactic airway diversion procedures, including prolonged endotracheal intubation or prophylactic tracheotomy. Such pro-cedures may mask neurological deterioration and delay maneuvers to correct it (e.g., prolonged intubation), or postpone rapid rehabilitation (e.g., tracheotomy). The purpose of this study was to determine the need for airway diversion procedures in anterior skull base surgery. The study reports our experience of 109 anterior skull base operations performed without prophylactic airway diversion. Fifty-nine patients underwent oncologic resection of tumor, 34 patients had reduction of complex frontonaso-orbital and skull base fractures, 13 patients underwent repair of cerebrospinal fluid leak, and 3 patients were operated due to anterior skull base fungal infections. The overall complication rate of nontension pneumocephalus was 4/109 (3.6%), including 2 oncological patients, and 2 patients suffering from skull base fractures. This complication rate is similar to or even lower than previously reported for operations performed with airway diversion procedures. It is concluded that prophylactic airway diversion such as prolonged intubation or elective tracheotomy is unnecessary in routine skull base operations, and is used only in cases in which factors predisposing to the risk of tension pneumocephalus are identified.