The magnetic resonance imaging profile of occult intracranial violations as a result of sinus surgery

Abstract

Introduction Intracranial injury is a well-described complication of sinus surgery. Although such complications are typically associated with catastrophic morbidity, the neurological sequelae may be subtle and even unrecognized during the postoperative period. Magnetic resonance imaging (MRI), which can distinguish intracranial hemorrhage and injury, may provide a means for the accurate assessment of atypical presentations of occult intracranial complications. Objective To describe the MRI profile of occult intracranial complications that result from unrecognized skull base violation during sinus surgery. Method Retrospective chart review. Results Two patients, who had endoscopic sinus surgery performed elsewhere, underwent postoperative MR for further evaluation of headache. The available medical records, as well as the patient's personal reports, suggested that no intraoperative cranial base compromise had occurred. Both MRIs showed abnormal signal intensity in the brain parenchyma adjacent to the floor of the anterior cranial fossa; these findings are consistent with traumatic injury presumably from the surgical procedure. Neither patient developed postoperative cerebrospinal fluid rhinorrhea, and neither patient experienced focal neurological deficits. Conclusion New-onset and/or atypical headache after sinus surgery may be associated with occult intracranial injury. MRI may serve as the diagnostic means for this occult intracranial violation. Significant incongruity may exist between patient symptoms and the objective MR evidence that can suggest serious intracranial injury. MRI signal patterns can provide both temporal and anatomical cues about the specific injury.