Preoperative disease severity at sites of subsequent skull base defects after endoscopic sinus surgery

Skull base (SB) injury is a known complication of endoscopic sinus surgery (ESS). Risk factors for SB injury include poor visualization, low-lying SB, and SB asymmetry. Anecdotal evidence indicates that many SB defects occur in areas with minimal mucosal disease adjacent to the SB. We evaluated preo...

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Bibliographic Details
Published in:American journal of rhinology 2008-05, Vol.22 (3), p.321-324
Main Authors: DelGaudio, John M, Mathison, Clyde C, Hudgins, Patricia A
Format: Article
Language:English
Subjects:
Adult
Aged
Cerebrospinal Fluid Rhinorrhea - diagnostic imaging
Cerebrospinal Fluid Rhinorrhea - etiology
Endoscopy - adverse effects
Female
Humans
Iatrogenic Disease
Intraoperative Complications - diagnostic imaging
Intraoperative Complications - etiology
Male
Middle Aged
Paranasal Sinus Diseases - surgery
Preoperative Care - methods
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Skull Base - diagnostic imaging
Skull Base - injuries
Tomography, X-Ray Computed
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Summary:Skull base (SB) injury is a known complication of endoscopic sinus surgery (ESS). Risk factors for SB injury include poor visualization, low-lying SB, and SB asymmetry. Anecdotal evidence indicates that many SB defects occur in areas with minimal mucosal disease adjacent to the SB. We evaluated preoperative computed tomography (CT) scans to determine the degree of mucosal disease present at the site of subsequent SB defects caused by ESS. Retrospective review of patients with SB injury as a result of ESS. Preoperative and postoperative CT films were reviewed for extent of overall sinus disease and disease at the site of the subsequent SB defect and presence of risk factors for SB injury. Preoperative and postoperative CT scans were obtained for 22 patients with 23 defects, who underwent 21 primary and 1 revision ESS. Fifteen (65%) patients had no disease, 2 (9%) patients had minimal disease, and 6 (26%) patients had complete opacification at the site of subsequent SB injury. SB defects occurred in the ethmoid roof (15 patients, 65%), lateral lamella (5 patients, 22%), cribriform plate (2 patients, 9%), and sphenoid sinus (1 patient, 4%). Risk factors for SB injury were only identified in 6 patients. SB injuries resulting from ESS occurred in SB regions with minimal or no mucosal disease in over two-thirds of cases. Explanations for this may include thinner bone and mucosa in areas without chronic disease that is easier to injure and less resistance to dissection in minimally diseased areas. Caution should always be exercised in ESS, but especially in minimally diseased areas.
ISSN:1050-6586
1945-8924
1539-6290
1945-8932
DOI:10.2500/ajr.2008.22.3173