Predictors of Operative Ischemic Cerebrovascular Complications in Skull Base Tumor Resections: Experience in Low Resource Setting

Abstract

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. A retrospective cohort study on predictors of ischemic cerebrovascular complications among patients who underwent skull base tumor resection was conducted at two high-volume neurosurgical centers in Ethiopia from 2018 - 2023. Binary logistic analysis was performed to see the association of each predictor variable. The study included 266 patients, with 65.5% being female. The median age and tumor size were 37 (±IQR=17) years and 4.9cm (± IQR 1.5) respectively. Ischemic cerebrovascular complications occurred in 19.9% of patients. Middle cranial fossa tumors and tumors spanning both anterior & middle cranial fossa (AOR = 6.75, 95% CI 1.66-27.54, p < 0.008), grade 3-5 vascular encasement (AOR = 5.04, 95% CI 1.79-14.12, p < 0.002), near-total resection and gross total resection (AOR = 2.89, 95% CI 1.01-8.24, p <0.048), and difficult hemostasis (AOR = 9.37, 95% CI 3.19-27.52, p < 0.000) were significantly associated with iatrogenic vascular injury. Sub-arachnoid hemorrhage had a statistically significant association with vasospasm (AOR = 12.27, 95% CI: 1.99-75.37, p = 0.007). 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's important to focus on improving neurosurgical setup to enhance patient outcomes.