Una técnica simple y segura para el tratamiento de las rinolicuorreas por pequeños defectos: colgajo libre de superposición «overlay» de mucosa nasal

Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience

“…FESS has become the standard surgical technique for the treatment of chronic sinusitis [13]; however, FESS is not without serious risks, mainly due to the anatomical complexities of the structures surrounding the sinuses (content ocular orbit, anterior cranial fossa, cavernous sinus and internal carotid artery) [2] [12]. Moreover, the operative field is formed by narrow slits with walls that bleed abundantly, sometimes only by contact with surgical instruments [8] [14].…”

“…Knowledge of patient anatomy and training for performance of meticulous surgical techniques are very important for avoiding complications [3] [13] [14]. However, even in the hands of well-trained surgeons, complications still occur [2] [3] [14], as happened in our patients: in two of the three cases, surgery was performed only by an experienced surgeon. The prevalence of intracranial complications in our patients was similar to that reported by other authors [1].…”

“…In addition, these inflammatory lesions bleed diffusely, preventing visual control. Early recognition and appropriate management of these complications is critical to minimizing the serious consequences that can threaten the life of the patient [2] [3] [7]. In addition, the postoperative period is critical to reducing the risk of permanent damage [2].…”

“…An intraoperative CSF leak is a clear risk factor for intracranial complications. If a CSF leak is recognized intraoperatively, repair should be initiated immediately [2] [10] [14]. However, repair does not always prevent the development of a complication, as occurred in patient number 2.…”

“…Major injuries and life-threatening endocranial complications include [1] involuntary penetration into the skull base, production of a cerebrospinal fluid (CSF) leak, meningitis, pneumocephalus and epidural or intracerebral abscess [1] [3] [5] [8] [9]. Knowledge of the mechanism of injury is essential for prevention, identification and immediate correction of these complications [2] [3] [5] [7].…”