Complications of venous insufficiency after neurotologic-skull base surgery

Objective: To characterize the incidence and complications resulting fi om venous insufficiency after neurotologic-skull base surgery. Study Design: Retrospective case review of >3,500 cases. Setting: Tertiary referral center, inpatient surgery. Patients: Six patients: four with complications related to chronic venous i nsufficiency and two with complications related to acute venous insufficien cy. Intervention(s): Medical (steroids, acetazolamide, hyperventilation, mannit ol) and surgical (lumboperitoneal shunt, optic nerve decompression, embolec tomy) interventions were under taken. Main Outcome Measure(s): Chronic venous insufficiency: nonobstructive hydro cephalus manifested by headache, disequilibrium, and papilledema with resul tant visual loss. Acute venous insufficiency: acute nonobstructive hydrocep halus resulting in mental status abnormalities in the: postoperative period . Conclusions: (1) Incidence of 1.5 per 1,000 cases. (2) Acute and chronic fo rms with different pathogenesis. (3) Acute form presents postoperatively wi th change in consciousness and herniation, and may proceed to death. (4) Ch ronic form presents months or years postoperatively with headache, disequil ibrium, and visual changes from papilledema. (5) Occurs almost solely in pa tients with preoperative abnormalities of the venous collecting system. (6) Causes mental status changes postoperatively.