Endoscopic repair of skull base defects presenting with pneumocephalus

Abstract

Objective: Persistent pneumocephalus often indicates the presence of a skull base (SB) defect associated with one of the paranasal sinuses. Such defects require treatment to avoid sequelae. The study objective was to evaluate success in endoscopic closure of SB defects associated with pneumocephalus.

Design: Retrospective medical record review.

Setting: Tertiary care academic rhinology practice.

Methods: A 5-year retrospective review of patients presenting with pneumocephalus. Presenting symptoms, etiology of SB defects, radiologic findings, operative techniques, and follow-up were evaluated.

Main outcome measures: Success of endoscopic SB defect repair in the setting of pneumocephalus was assessed. Factors potentially contributing to failure were evaluated in appropriate cases.

Results: Eleven patients with pneumocephalus from 14 SB defects underwent 17 endoscopic repairs. In 11 surgical procedures, active cerebrospinal fluid (CSF) leaks were identified, but in the remaining 6, pneumocephalus was present without CSF leak. Radiologic location of pneumocephalus ranged from extra-axial to diffuse within the brain parenchyma. SB defects were identified using fine-cut computed tomographic (CT) scans, CT cisternograms, and intrathecal fluorescein. Defects were located in the sphenoid, sella, ethmoid roof, and frontal sinus posterior table. Eight of 11 patients (72%) were managed with endoscopic repair alone. Factors potentially affecting failure included malignancy, previous radiation, intracranial infection, malnutrition, and Cushing disease.

Conclusions: Endoscopic SB defect repair for pneumocephalus is largely successful. Localization of SB defects in these cases is often assisted by CT cisternography and intrathecal fluorescein.