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.
Highlights
Functional Endoscopic Sinus Surgery (FESS) is the therapeutic method of choice in surgical therapy of chronic sinusitis [1]-[4]
We performed a retrospective review of all FESS performed in our department between 2003 and 2012 and the reported cases of endocranial complications that occurred
The patient was treated by absolute rest and prophylactic antibiotics for 2 weeks, with a favorable evolution and without incidence
Summary
Functional Endoscopic Sinus Surgery (FESS) is the therapeutic method of choice in surgical therapy of chronic sinusitis [1]-[4]. FESS is considered safe when performed by experienced surgeons [5] [6], complications continue to be reported despite technical and instrumental advances [1] [7]-[9]. These complications are divided into major and minor categories [1] [8] [10]: intra/postoperative and immediate/delayed [1] [5] [8] [10]. The rise in FESS indications has resulted in an increase in endocranial complications [4]. Defining the true incidence of these complications is impeded by significant variability of reports among authors [6] [8] [11]
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