Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience

Abstract

Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis; a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur; and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intraoperative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…The intracranial complications included 14 CSF leaks, 3 direct frontal lobe injuries, 1 incident of subarachnoid hemorrhage, 2 cases of meningitis, and 3 cases of pneumocephalus. Pneumocephalus is a rare neurological complication of ESS, and other than those reviews 1362,1363 previously described, other case reports 1364,1365 of pneumocephalus after ESS seem to imply that this complication is sufficiently managed with endoscopic closure. 1366 Microdebriders or tissue shavers have revolutionized the manner in which ESS is performed.…”

“…Armengot-Carcellar et al 1362 reported a 0.39% incidence of intracranial complications in 763 patients; 3 patients developed CSF rhinorrhea, 1 of which developed a brain abscess requiring incision and drainage. Hou et al 1363 reviewed their series of ESS and found 19 cases of intracranial complications.…”