Neurologic sequelae associated with delayed identification of iatrogenic skull base injury during endoscopic sinus surgery (ESS).
BACKGROUND
Skull base injury is an infrequent complication during endoscopic sinus surgery (ESS). We hypothesize that late recognition and repair of CSF leaks during ESS is associated with increased neurologic morbidity.


METHODS
A retrospective review was performed of patients with skull base injury during ESS at a tertiary center from 1999-2015. The study population was separated into early (less than 72 hrs) and late (more than 72 hrs) intervention groups. Study parameters included time to diagnosis, imaging, site of injury, type of repair, neurologic complications, and clinical outcomes.


RESULTS
Seventeen patients were studied. The primary surgical interventions included ESS and balloon sinuplasty. Mean latency from primary surgery to presentation to our facility was 11 days. The most common injury site was the cribriform plate and the mean defect size 4.5 mm. Late diagnosis was associated with increased total neurologic complications and increased rates of postoperative meningitis. No neurologic complications occurred in patients diagnosed intraoperatively. All patients underwent successful endoscopic repair.


CONCLUSIONS
Skull base injury is a rare but major complication following both balloon sinuplasty and traditional primary ESS. Early diagnosis and endoscopic repair may prevent neurologic morbidity in these patients.
Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
M
M
Kubik
Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
S
S
Lee
Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
C
C
Snyderman
Center for Cranial Base Surgery, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
E
E
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D057210:Delayed Diagnosis / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D019291:Skull Base / Q000293:injuries* / Q000601:surgery; D055815:Young Adult