Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience
Affiliation(s)
1 ENT Department, Surgery Department, Valencia University, General and University Hospital, Valencia, Spain. 2 ENT Department, General and University Hospital, Valencia, Spain.
1 ENT Department, Surgery Department, Valencia University, General and University Hospital, Valencia, Spain. 2 ENT Department, General and University Hospital, Valencia, Spain.
ABSTRACT
Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis; a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur; and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intra-operative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.
Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis; a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur; and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intra-operative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.
KEYWORDS
Cerebral Abscess, Cerebrospinal Fluid Leak, Inflammatory Sinus Disease, Pneumocephalus, Polyposis
Cerebral Abscess, Cerebrospinal Fluid Leak, Inflammatory Sinus Disease, Pneumocephalus, Polyposis
Cite this paper
Armengot-Carceller, M. and Hernandez-Sandemetrio, R. (2014) Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience. International Journal of Otolaryngology and Head & Neck Surgery, 3, 298-303. doi: 10.4236/ijohns.2014.35053.
Armengot-Carceller, M. and Hernandez-Sandemetrio, R. (2014) Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience. International Journal of Otolaryngology and Head & Neck Surgery, 3, 298-303. doi: 10.4236/ijohns.2014.35053.
References
[1] Tabaee, A., Kacker, A., Kassenoff, T.L. and Anand, V. (2003) Outcome of Computer-Assisted Sinus Surgery: A 5-Year Study. American Journal of Rhinology, 17, 291-297. [2] Armengot, M., Gómez-Gómez, M.J. and García-Lliberós, A. (2013) A Simple and Reliable Technique for the Treatment of Rhinoliquorrhoea from Small Defects: Free Nasal Mucosa Overlay Graft. Neurocirugia, 24, 197-203.
http://dx.doi.org/10.1016/j.neucir.2013.03.002 [3] Asaka, D., Nakayama, T., Hama, T., et al. (2012) Risk Factors for Complications of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. American Journal of Rhinology & Allergy, 26, 61-64. [4] Heaton, C., Goldberg, A.N., Pletcher, S.D. and Christine, M. (2012) Sinus Anatomy Associated Inadvertent Cerebrospinal Fluid Leak during Functional Endoscopic Sinus Surgery. Laryngoscope, 122, 1446-1449.
http://dx.doi.org/10.1002/lary.23305 [5] Dalgorf, D.M., Sacks, R., Wormald, P.J., et al. (2013) Image-Guided Surgery Influences Perioperative Morbidity from Endoscopic Sinus Surgery: A Systematic Review and Meta-Analisis. Otolaryngology—Head and Neck Surgery, 149, 17-29.
http://dx.doi.org/10.1177/0194599813488519 [6] Ruiz-Juretschke, F., Mateo-Sierra, O., Iza-Vallejo, B. and Carrillo-Yagüe, R. (2007) Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: presentación de un caso y revisión de la literatura. Neurocirugía, 18, 134-137. [7] Fokkens, W.J., Lund, V.J., Mullol, J., Bachert, C., Alobid, I., Baroody, F., et al. (2012) European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology Supplement, 23, 1-298. [8] Levine, H.L. (1990) Functional Endoscopic Sinus Surgery: Evaluation, Surgery and Follow-Up of 250 Patients. Laryngoscope, 100, 79-84.
http://dx.doi.org/10.1288/00005537-199001000-00016 [9] Christopher McMains, K. (2008) Safety in Endoscopic Sinus Surgery. Current Opinion in Otolaryngology & Head and Neck Surgery, 16, 247-251.
http://dx.doi.org/10.1097/MOO.0b013e3282fdccad [10] Lund, V.J., Stammberger, H., Nicolai, P., Castelnuovo, P., Beal, T., Beham, A., et al. (2010) European Position Paper on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base. Rhinology Supplement, 22, 1-143. [11] Maier, W. and Laszig, R. (2003) Complications of Endonasal Paranasal Sinus Surgery—Diagnostic and Therapeutic Consequences. American Journal of Rhinology, 17, 291-297. [12] Maniglia, A.J. (1989) Fatal and Major Complications Secondary to Nasal and Sinus Surgery. The Laryngoscope, 99, 276-383. [13] Maniglia, A.J. (1991) Fatal and Others Major Complications of Endoscopic Sinus Surgery. The Laryngoscope, 101, 349-354. [14] Ortega, P., Gómez-Ullate, J. and García-Polo, J. (2001) Complicaciones de la cirugía endoscópica nasosinusal. In: Bernal, M., Massegur, H., Sprekelsen, C., Ademá, J.M., Fabra J.M. and Moina, H., Eds., Cirugía Endoscópica Nasosinusal Básica y Avanzada, Gràfiques Alzamora, Girona, 257-279. [15] Reyt, E., Righini, C., Schmerber, S. and Karkas, A. (2011) Rhinorrhées cérébrospinales. EMC, Elsevier Mason SAS, Paris, Otorhino-laryngologie, 20-365-A-10. [16] Ulualp, S.O. (2008) Complications of Endoscopic Sinus Surgery: Appropiate Management of Complications. Current Opinion in Otolaryngology & Head & Neck Surgery, 16, 252-259.
http://dx.doi.org/10.1097/MOO.0b013e3282fdc3b2 [17] Stankiewicz, J.A. (1987) Complications of Endoscopic Intranasal Ethmoidectomy. The Laryngoscope, 97, 1270-1273.
http://dx.doi.org/10.1288/00005537-198711000-00004
[1] Tabaee, A., Kacker, A., Kassenoff, T.L. and Anand, V. (2003) Outcome of Computer-Assisted Sinus Surgery: A 5-Year Study. American Journal of Rhinology, 17, 291-297. [2] Armengot, M., Gómez-Gómez, M.J. and García-Lliberós, A. (2013) A Simple and Reliable Technique for the Treatment of Rhinoliquorrhoea from Small Defects: Free Nasal Mucosa Overlay Graft. Neurocirugia, 24, 197-203.
http://dx.doi.org/10.1016/j.neucir.2013.03.002 [3] Asaka, D., Nakayama, T., Hama, T., et al. (2012) Risk Factors for Complications of Endoscopic Sinus Surgery for Chronic Rhinosinusitis. American Journal of Rhinology & Allergy, 26, 61-64. [4] Heaton, C., Goldberg, A.N., Pletcher, S.D. and Christine, M. (2012) Sinus Anatomy Associated Inadvertent Cerebrospinal Fluid Leak during Functional Endoscopic Sinus Surgery. Laryngoscope, 122, 1446-1449.
http://dx.doi.org/10.1002/lary.23305 [5] Dalgorf, D.M., Sacks, R., Wormald, P.J., et al. (2013) Image-Guided Surgery Influences Perioperative Morbidity from Endoscopic Sinus Surgery: A Systematic Review and Meta-Analisis. Otolaryngology—Head and Neck Surgery, 149, 17-29.
http://dx.doi.org/10.1177/0194599813488519 [6] Ruiz-Juretschke, F., Mateo-Sierra, O., Iza-Vallejo, B. and Carrillo-Yagüe, R. (2007) Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: presentación de un caso y revisión de la literatura. Neurocirugía, 18, 134-137. [7] Fokkens, W.J., Lund, V.J., Mullol, J., Bachert, C., Alobid, I., Baroody, F., et al. (2012) European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology Supplement, 23, 1-298. [8] Levine, H.L. (1990) Functional Endoscopic Sinus Surgery: Evaluation, Surgery and Follow-Up of 250 Patients. Laryngoscope, 100, 79-84.
http://dx.doi.org/10.1288/00005537-199001000-00016 [9] Christopher McMains, K. (2008) Safety in Endoscopic Sinus Surgery. Current Opinion in Otolaryngology & Head and Neck Surgery, 16, 247-251.
http://dx.doi.org/10.1097/MOO.0b013e3282fdccad [10] Lund, V.J., Stammberger, H., Nicolai, P., Castelnuovo, P., Beal, T., Beham, A., et al. (2010) European Position Paper on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base. Rhinology Supplement, 22, 1-143. [11] Maier, W. and Laszig, R. (2003) Complications of Endonasal Paranasal Sinus Surgery—Diagnostic and Therapeutic Consequences. American Journal of Rhinology, 17, 291-297. [12] Maniglia, A.J. (1989) Fatal and Major Complications Secondary to Nasal and Sinus Surgery. The Laryngoscope, 99, 276-383. [13] Maniglia, A.J. (1991) Fatal and Others Major Complications of Endoscopic Sinus Surgery. The Laryngoscope, 101, 349-354. [14] Ortega, P., Gómez-Ullate, J. and García-Polo, J. (2001) Complicaciones de la cirugía endoscópica nasosinusal. In: Bernal, M., Massegur, H., Sprekelsen, C., Ademá, J.M., Fabra J.M. and Moina, H., Eds., Cirugía Endoscópica Nasosinusal Básica y Avanzada, Gràfiques Alzamora, Girona, 257-279. [15] Reyt, E., Righini, C., Schmerber, S. and Karkas, A. (2011) Rhinorrhées cérébrospinales. EMC, Elsevier Mason SAS, Paris, Otorhino-laryngologie, 20-365-A-10. [16] Ulualp, S.O. (2008) Complications of Endoscopic Sinus Surgery: Appropiate Management of Complications. Current Opinion in Otolaryngology & Head & Neck Surgery, 16, 252-259.
http://dx.doi.org/10.1097/MOO.0b013e3282fdc3b2 [17] Stankiewicz, J.A. (1987) Complications of Endoscopic Intranasal Ethmoidectomy. The Laryngoscope, 97, 1270-1273.
http://dx.doi.org/10.1288/00005537-198711000-00004