The role of endonasal endoscopic skull base repair in posttraumatic tension pneumocephalus
Document Type
Article
Publication Date
5-1-2022
Abstract
Objectives: Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course. Methods: The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea. Results: Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/ 7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases. Conclusions: Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented.
Keywords
Cerebrospinal fluid diversion, cerebrospinal fluid leak, endonasal endoscopic approach, posttraumatic hydrocephalus, posttraumatic tension pneumocephalus
Divisions
otorhino
Funders
Department of Surgery of the University Hospital of Basel (Basel, Switzerland),Gottfried and Julia Bangerter-Rhyner Foundation (Bern, Switzerland),Lionel College Travel Fellowship fund (United Kingdom),Departments of Neurosurgery of the University Hospital of Basel (Basel, Switzerland),University of Malaya Specialist Centre (Kuala Lumpur, Malaysia)
Publication Title
Journal Of Craniofacial Surgery
Volume
33
Issue
3
Publisher
Lippincott Williams & Wilkins
Publisher Location
TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA