Fehler und Gefahren: Eingriffe an den Nasennebenhöhlen und der Frontobasis unter Berücksichtigung mediko-legaler Aspekte

Abstract

Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5-1%.A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education.

Comprehensive review on rhino-neurosurgery

“…Measures for hemostasis during nasal and paranasal (extradural) phases of preparation correspond to usual practices of sinus surgery [ 3 ], [ 11 ], [ 399 ]. Generally, a distinction may be drawn according to the bleeding source (artery, vein) and the bleeding quality (low-flow, high-flow).…”

“…Generally the size, position, and origin of the dura defect as well as the type and the material of the closure are less important for the success of the measure than an appropriate surgical technique [ 492 ], [ 510 ], [ 511 ], [ 512 ], [ 513 ]. Those principles are known from surgery of the paranasal sinuses [ 11 ], [ 399 ]. Persistence or recurrent fistula can develop based on intracranial hypertension.…”

“…Part of the complications of rhino-neurosurgical interventions corresponds to undesired events as they generally may occur also in routine surgery of the paranasal sinuses [ 399 ].…”

“…Furthermore, a series of well-known rhinosurgical complications may occur associated with the creation of the special surgical corridors. Examples are postoperative bleedings, synechia, sinusitis, mucoceles, atrophic rhinitis, bleeding into the orbita, injury of the medial rectus muscle, or pneumocephalus and tension pneumocephalus [ 277 ], [ 399 ]. After rhino-neurosurgical interventions, those known complications, however, are associated with specific requirements.…”

Pediatric radiology in oto-rhino-laryngology

“…It is the surgeon’s responsibility to decide if the anatomic situation of an individual case is sufficiently described by a certain imaging method. Generally CT scan, DVT, and MRI are not completely comparable, but all are appropriate for guiding a surgical intervention [ 18 ].…”