Perioperative nebulized budesonide and L-Cysteine reduce pulmonary complications after posterior skull base tumor resection: a randomized controlled trial.

INTRODUCTION

Perioperative pulmonary complications are a leading cause of morbidity and mortality in patients undergoing Posterior skull base tumors surgery.

OBJECTIVE

To evaluate the efficacy and safety of perioperative nebulized inhalation of budesonide combined with L-cysteine in reducing pulmonary complications in patients undergoing surgery for posterior skull base tumors, explore subgroup-specific effects based on tumor location such as the jugular vein region, and identify independent risk factors for pulmonary complications.

METHODS

This prospective, randomized, controlled trial was conducted at a tertiary academic medical center between May 1, 2020, and May 1, 2023. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000032022) on 2020-04-17 prior to patient recruitment. Patients with posterior skull base tumors scheduled for surgical resection were randomly assigned to either the intervention group or the control group. Patients were stratified into four subgroups based on tumor location: cerebellopontine angle (CPA), clivus, foramen magnum, and jugular vein region. The primary outcome was the incidence of overall pulmonary complications within 30 days postoperatively, including pneumonia, acute respiratory distress syndrome (ARDS), atelectasis, and bronchospasm. Secondary outcomes included the severity of pulmonary complications using Clavien-Dindo classification, length of hospital stay (LOS), intensive care unit (ICU) admission rate, and mortality.

RESULTS

A total of 1200 patients with posterior skull base tumors were included in the study. The intervention group had a significantly lower incidence of overall pulmonary complications than the control group (12.3% vs. 21.7%, P < 0.001). Subgroup analysis revealed consistent protective effects across all tumor locations, with the greatest magnitude observed in the foramen magnum subgroup (10.2% vs. 28.3%, P < 0.001) and jugular vein region subgroup (11.0% vs. 26.7%, P < 0.001), followed by the clivus (11.5% vs. 20.1%, P = 0.002) and CPA (13.1% vs. 19.8%, P = 0.012) subgroups.

CONCLUSION

Perioperative nebulized inhalation of budesonide combined with L-cysteine was independently associated with a reduced risk of pulmonary complications in patients with posterior skull base tumors, with consistent benefits across all tumor location subgroups.