Title : Predictors of operative ischemic cerebrovascular complications in skull base tumor resections: Experience in low-resource setting
Abstract:
Background: Ischemic cerebrovascular complications following skull base tumor resections remain a significant factor impacting both short-term and long-term patient outcomes. This study aims to improve risk stratification, surgical decision-making, and postoperative care protocols.
Methods: A retrospective cohort study on predictors of ischemic cerebrovascular complications among patients who underwent skull base tumor resection was conducted at 2 high-volume neurosurgical centers in Ethiopia from 2018 to 2023. Binary logistic analysis was performed to see the association of each predictor variable.
Results: The study included 266 patients, with 65.5% being female. The median age and tumor size were 37 (± IQR = 17) years and 4.9 cm (± IQR 1.5), respectively. Ischemic cerebrovascular complications occurred in 19.9% of patients. Middle cranial fossa tumors and tumors spanning both anterior and middle cranial fossa (AOR = 6.75, 95% CI: 1.66-27.54, P < .008), grades 3-5 vascular encasement (AOR = 5.04, 95% CI: 1.79-14.12, P < .002), near-total resection and gross total resection (AOR = 2.89, 95% CI: 1.01-8.24, P < .048), and difficult hemostasis (AOR = 9.37, 95% CI: 3.19-27.52, P < .000) were significantly associated with iatrogenic vascular injury. Subarachnoid hemorrhage had a statistically significant association with vasospasm (AOR = 12.27, 95% CI: 1.99-75.37, P = .007).
Conclusions: Surgery-related ischemic cerebrovascular complications are common. Thorough perioperative risk stratification and proactive treatment planning are crucial to mitigate vascular insults associated with it. In low-resource settings, neurosurgical services are provided without advanced instruments, leading to more complications. Therefore, it is important to focus on improving neurosurgical setup to enhance patient outcomes.
