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Review
. 2022 May 1;33(3):875-881.
doi: 10.1097/SCS.0000000000008204. Epub 2021 Oct 12.

The Role of Endonasal Endoscopic Skull Base Repair in Posttraumatic Tension Pneumocephalus

Martina Dalolio  1   2 , Dominik Cordier  1 , Saif Al-Zahid  3 , Warren O Bennett  3   4 , Narayanan Prepageran  3 , Vicknes Waran  5 , Luigi Mariani  1 , Ruth Koeppl  6 , Yves Brand  1   7 , Michel Roethlisberger  1   3   5
Affiliations
Review

The Role of Endonasal Endoscopic Skull Base Repair in Posttraumatic Tension Pneumocephalus

Martina Dalolio et al. J Craniofac Surg. .

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.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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