Tension Pneumocephalus after Endoscopic Sinus Surgery: A Technical Report of Multiportal Endoscopic Skull Base Repair

Abstract

Objectives: Large skull base defects and cerebrospinal fluid (CSF) leak repairs are traditionally performed through a transnasal endoscopic approach or an open craniotomy approach. While this is often successful, when the defect is adjacent to the crista galli it can be very difficult to seal the medial portions of the defect. Our objective is to report our experience using a novel multiportal (transnasal and transorbital) endoscopic technique to repair large, bilateral anterior cranial fossae defects using an intracranial “brain sling.” Methods: Reviews of the literature and medical records were performed. Results: Endoscopic transnasal and transorbital repair of large bilateral anterior cranial fossae skull base defects was performed using acellular radiated cadaver dermis and collagen matrix through a multiportal approach. The visualization and surgical access through transorbital portals permitted an intracranial extradural/intradural repair using a single, large section of reconstruction material. It was introduced through a portal distant to the site of injury to avoid enlarging the region of damage, and fashioned so that forces of gravity maintained its proper position. All leaks were repaired successfully with one surgical procedure, and there were no surgical complications in the cohort. Conclusions: The “brain sling” technique is applicable to the reconstruction of large skull base defects of any etiology and may be important for oncologic reconstruction. By using a multiportal approach, instrumentation could be performed without blocking the endoscopic view, and multiple viewing angles of the pathology could be used to improve the surgical efficacy.