Complications of pediatric endoscopic sinus surgery: The diagnosis and management of cerebrospinal fluid rhinorrhea

Abstract

Major complications of endoscopic sinus surgery may be classified into two broad categories: orbital and intracranial. Significant complications are usually the result of poor appreciation of anatomic relationships, poor visualization, or excessive bleeding. Cerebrospinal fluid (CSF) fistulas represent a life-threatening complication of endoscopic sinus surgery (ESS) and may result in meningitis or brain abscess. The incidence of CSF fistula is less than 1% following endoscopic sinus surgeryi-‘i (Table 1) and compares favorably with traditional transnasal ethmoidectomy. i2-16 The use of ESS in pediatric sinusitis has generated few reports of complications. In the pediatric population, the lack of reported CSF fistulas may be secondary to less extensive surgery, less developed sinuses (with thicker bone), or thicker dura. Thus, the management of potential complications must be based on the adult literature as well as experience with the pediatric trauma patient. The diagnosis and management of CSF fistulas secondary to ESS are reviewed and formulate the basis of our current recommendations.