Placement of NP Airways after Skull Base Tumor Resection

Abstract

Objective: 1) Assess the efficacy of nasopharyngeal (NP) airways in lieu of tracheotomy to prevent tension pneumocephalus after open resection of anterior skull base (ASB) tumors. 2) Determine predictors of tension pneumocephalus in patients undergoing NP airway placement after open resection of ASB tumors.

Method: A total of 121 ASB resections (mean age, 48.5 years; M:F 73:47) performed between 1994 to 2009 with documented NP airway placement were identified and charts retrospectively reviewed. Main outcome measures were presence of tension pneumocephalus, while controlling for other clinical parameters (presence of CSF leak, placement of lumbar drain, type of reconstruction).

Results: All patients were extubated on the day of surgery and NP airways remained in place for 3 days; no complications from NP airways were seen (eg, nasal septal pressure necrosis, displacement of the tubes). A total of 3 (2.5%) cases of tension pneumocephalus occurred. There were 34 (28%) lumbar drains placed and 14 (12%) CSF leaks. Although only 3 events were recorded, there was a statistically significant difference in the rate of tension pneumocephalus stratified by lumbar drain placement (P = .02), presence of CSF leak (P = .04), and both together (P = .004). Type of reconstruction did not affect rate of tension pneumocephalus (P = 1.0).

Conclusion: Resection of anterior skull base tumors does not necessitate prophylactic tracheotomy and use of a nasopharyngeal airway to divert airflow is well tolerated and highly successful. Lumbar drainage, the presence of a CSF leak, or both together may increase the risk of tension pneumocephalus.