Factors Contributing to Failure in Endoscopic Skull Base Defect Repair

Abstract

Although endoscopic repair of SB defect remains largely successful, certain factors should alert the surgeon to the potential for failure of repair or need for secondary SB defect repair.

Endonasal Endoscopic Approach in Management of Paediatric CSF Rhinorrhoea Cases

“…So we avoided using it in our patients even though it is a very effective measure. There are usually six main locations of the skull base defect, these include the sella, sphenoid sinus, ethmoid roof, olfactory cleft, frontal sinus/recess and middle cranial fossa [19], the most common being ethmoid roof as is also seen in our series. Though the literature mentions a definitive role of lumbar drain especially in high pressure leaks and in cases of large dural defects [20][21][22], we did not use it in our paediatric patients to avoid discomfort and displacement, as it would be hard to control the child's activities when the child is already irritated by nasal packing and also to decrease the ICU stay.…”

“…It has also been postulated that an endoscopic approach may not be successful in cases with multiple defects or where the defect is not well defined [24] and Infection or severe inflammation within the nasal cavity can also make endoscopic repair a difficult option, so a preoperative work up and prophylactic antibiotics do have a major role in the management of these patients especially in paediatric age group [25]. Causes of failure have always been a topic of controversy, but according to a study by Wise et al [19] increased intracranial pressure usually associated with spontaneous leaks have a poor prognosis and also the fact that these leaks are usually from the lateral recess of sphenoid which is more difficult to treat. They also postulated that a prior history of craniotomy, suggestive of a possible large defect, poor wound healing such as after radiotherapy and secondary surgeries are associated with poorer results.…”

Frontal sinus cancer resection and reconstruction

“…10 The cancer in this case was not susceptible for endoscopic approach due to sheer size and inability to endoscopically localize the skull base defect. 11 …”

Idiopathic sphenoid sinus CSF rhinorrhoea

“…Endoscopic repair of skull base defects is successful in over 90% of cases 8. The factors responsible for failure of skull base repair techniques or need for secondary repair are inability to localise the defect, development of new defect, prior sinus or skull base surgery or craniotomy, prior radiation therapy and intracranial infection 8…”