gms | German Medical Science

Objective: Routine Sinonasal surgery is widely practiced and is considered as save procedure. Skull base injuries related to this surgery occur in less than 1% and their most frequent manifestation is rhinorrhea. Brain injuries have been reported only extraordinary. Here we present a series of four patients with iatrogenic brain injuries after routine sinonasal surgery.

Methods: Four patients with penetrating skull base fractures after routine sinonasal surgery and subsequent brain injury were identified within a 10-years period. Procedures performed were endoscopic sinus surgery in three patients and microscopic sinus surgery in one patient.

Results: There were three men, and one woman. Mean age at surgery was 50 years (range 28-66 years). All operations had been performed under general anesthesia. In three instances (in which an endoscope was used), the ENT physician had noted the perforation of the skull base during the surgery, but it went unnoticed in one patient operated with microscope. In two patients the cribriform plate was perforated, and in the other two patients the perforation canal was through the ethmoidal roof. The frontal lobe injured by blunt instruments. Hemorrhagic lesions were present in all instances, and in 3 patients infarction related to the injury of branches of the anterior cerebral artery occurred. Two patients with a vascular injury developed an acute global brain edema and succumbed despite maximal surgical and non-surgical treatment. The other two patients survived with minor neurological deficits.

Conclusion: Brain injury secondary to sinonasal surgery is rare but presumably underreported. While sometimes brain injury might even not be noticed in the intra- and postoperative setting, it might also result in catastrophic outcome. Associated vascular injuries harbour a dismal prognosis.