J Rhinol.  2023 Jul;30(2):115-119. 10.18787/jr.2023.00021.

Iatrogenic Skull Base Defect Accompanied by Brain Injury After Endoscopic Sinus Surgery: A Report of Two Cases

• Kim T
• Go J
• Yu MS

• KMID: 2544621
• DOI: http://doi.org/10.18787/jr.2023.00021

Abstract

Although iatrogenic skull base injuries after endoscopic sinus surgery (ESS) are rare (overall complication rate, 0.5%), they can be fatal or cause significant morbidity. Conventionally, skull base injuries were repaired using an external approach. However, in recent years, most skull base injuries after ESS have been repaired using an endoscopic transnasal approach due to its lower morbidity, lower risk of postoperative complications, and shorter hospital stay. We report two cases of iatrogenic skull base injury accompanied by brain injury following ESS and describe the skull base repair techniques employed for each case. In both cases, the skull base defects were successfully repaired using an endoscopic transnasal approach, although craniotomy was also performed in the first case to remove bone fragments from the right frontal base and lateral ventricle. Both patients recovered without residual neurologic deficits.

Keyword

Endoscopic sinus surgery; Iatrogenic skull base injury; Skull base repair

Figure

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  Fig. 1. Preoperative computed tomography findings. Intracranial pneumocephalus (A). Subdural hemorrhage in the right frontal base (arrowhead) (A, B). Multifocal bone fragments in the right frontal base and lateral ventricle (arrow) (B, C). A 1×2.5 cm right anterior skull base defect (circle) (A, C).

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  Fig. 2. Endoscopic intranasal images. Intraoperative findings (A, B): right anterior ethmoid roof defect (arrow). Pericranial flap reconstruction (★). Endoscopic view of well-healed reconstruction site at a 23-month follow-up (arrowhead) (C).

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  Fig. 3. Preoperative computed tomography findings. Intraorbital emphysema in the left orbit (arrows) (A). Multifocal intracranial pneumocephalus (arrowhead) (B-D). Intracranial hemorrhage in the left inferomedial frontal lobe and basal ganglia (★) (E, F). A 4×1.5 cm right anterior skull base defect (circle) (B, D).

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  Fig. 4. Endoscopic intranasal images. Intraoperative findings (A, B): left anterior ethmoid roof defect (arrow). Nasoseptal flap reconstruction (★). Endoscopic view of the well-healed reconstruction site at a 9-month follow-up (arrowhead) (C).

Reference

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