Fatal and Other Major Complications of Endoscopic Sinus Surgery

Death Related to Nasal Surgery

“…16 -18 An increased risk occurs in patients with a low-lying ethmoid plate, found at a level inferior to two-thirds of the orbit on preoperative CT. 16 Unlike damage to the ICA, which is commonly recognized during surgery, these cases may go unrecognized until complications are noted postoperatively. 16,17 In our patient and in another case, the bleeding was found only when the patient did not wake from anesthesia. 16 Other cases were discovered after a CSF leak was found postoperatively (2 cases), with excessive bleeding during surgery, and with suspicion by the surgeon for intracranial entry during surgery.…”

“…16 Other cases were discovered after a CSF leak was found postoperatively (2 cases), with excessive bleeding during surgery, and with suspicion by the surgeon for intracranial entry during surgery. 17,18 The relatively large amount of blood loss in our case, in retrospect, may have provided a clue that a vascular injury had occurred. For those with subarachnoid hemorrhage who awaken from anesthesia (4 cases), 3 cases had no significant sequelae and one case resulted in severe frontal lobe syndrome and anosmia.…”

“…14,15 Our case represents a situation of direct damage to the anterior cerebral artery resulting in mortality, which to our knowledge, has only been reported once previously in association with this type of surgery; however, the mortality occurred in relation to treatment of a malignancy rather than benign disease as in our case. 17 Other cases of intracerebral hemorrhage as a result of this surgery have been reported, both with and without significant sequelae. Four of these have a seemingly similar mechanism of injury to our case.…”

Schwere Komplikationen nach endonasalen Nasennebenh�hlenoperationen?ein ungekl�rtes Problem

“…Dort kann u. U. die knöcherne Hülle des Nerven fehlen. Maniglia beschreibt 1989 und 1991 2 Fälle, bei denen die direkte Schädigung des Sehnerven zur Blindheit führte [10,11]. Neuhaus beschreibt 1990 einen Fall mit einer Einschränkung des Sehfeldes infolge einer direkten Nervschädigung [12].…”

Komplikationen nach endonasalen Eingriffen bei entzündlichen NNH-Erkrankungen

“…Bei der historischen Betrachtung der Anfänge der endoskopischen NNH-Chirurgie fanden insbesondere solche Publikationen Aufmerksamkeit, die von zum Teil schwerwiegenden Komplikationen berichteten [1]. Einige Untersuchungen über endonasale NNH-Eingriffe konnten einerseits nachweisen, dass erfahrene Operateure und Ausbildungskliniken eine höhere Komplikationsrate aufwiesen [2,3] andererseits sprachen andere Publikationen von einer Lernkurve bei diesen Eingriffen, bei der zu Beginn mit mehr Komplikationen zu rechnen sei [4,5].…”