Is it safe to resume continuous positive airway pressure therapy early after endoscopic transsphenoidal surgery? An illustrated narrative review.

BACKGROUND: Although the timing of continuous positive airway pressure (CPAP) resumption after endoscopic transsphenoidal surgery (ETSS) remains controversial in the absence of definitive evidence, recent literature suggests early CPAP resumption may be safer than historically assumed in carefully selected patients. This review aims to (1) summarize the existing evidence available in this field, (2) identify which factors modulate the risk of pneumocephalus when resuming CPAP early after ETSS, and (3) outline the key perioperative measures known to reduce the need for CPAP by minimizing the risk of postoperative pulmonary complications. METHODS: We conducted a narrative review using evidence gathered first from the PubMed and Embase databases, then from dual citation chaining. To illustrate the review, we present two new cases from our institution that were managed differently because of distinct risk profiles. RESULTS: We identified a total of 883 studies, including 123 that directly addressed the issue of PNC. The available evidence supporting the safe resumption of CPAP early after ETSS was limited to case reports and case series. We identified anatomical, surgical, and physiological factors associated with the risk of CPAP-induced PNC. CONCLUSION: There is insufficient evidence to draw definitive conclusions on the safety of resuming CPAP early after ETSS. The two cases we present highlight the importance of tailoring anesthetic and surgical care to individual risk factors, and of promoting multidisciplinary collaboration to achieve optimal results.