Management of the airway in a neurosurgical patient with idiopathic skeletal hyperostosis

Abstract

Introduction: Idiopathic diffuse skeletal hyperostosis, initially described as senile ankylosing hyperostosis by Forestier and Rotes-Querol in 1950 and further characterized with radiological diagnostic criteria by Resnick and Niwayama in 1976, is a condition marked by ossification of the anterior longitudinal vertebral ligament. This disorder, associated with conditions such as obesity, hypertension, and diabetes, can impair cervical mobility and pose significant challenges in anesthetic management due to restricted movement and structural alterations of the airway.  Objective: To describe the airway management strategy for a patient with DISH undergoing endoscopic endonasal surgery.

Case report: A 59-year-old male with severe DISH and radiological evidence of a sellar tumor with suprasellar extension was scheduled for endoscopic endonasal surgery. Preoperative evaluation revealed a difficult airway due to extreme cervical limitation and anatomical abnormalities. Awake fiberoptic intubation was performed, optimized with bilateral superior laryngeal nerve blocks and topical anesthesia to minimize risks. The surgery was completed successfully without respiratory or hemodynamic complications, and the patient experienced a favorable postoperative course.

Conclusions: Idiopathic diffuse skeletal hyperostosis presents a significant challenge for anesthetic management due to limited cervical mobility and anatomical airway alterations. Awake fiberoptic intubation remains the technique of choice, as it minimizes the risk of complications. This approach ensures optimal outcomes in complex surgical procedures, particularly in neurosurgical patients.