The role of endonasal endoscopic skull base repair in posttraumatic tension pneumocephalus

Dalolio, Martina and Cordier, Dominik and Al-Zahid, Saif and Bennett, Warren O. and Narayanan, Prepageran and Mathaneswaran, Vickneswaran and Mariani, Luigi and Koeppl, Ruth and Brand, Yves and Roethlisberger, Michel (2022) The role of endonasal endoscopic skull base repair in posttraumatic tension pneumocephalus. Journal Of Craniofacial Surgery, 33 (3). pp. 875-881. ISSN 1049-2275, DOI

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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.

Item Type: Article
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)
Uncontrolled Keywords: Cerebrospinal fluid diversion; cerebrospinal fluid leak; endonasal endoscopic approach; posttraumatic hydrocephalus; posttraumatic tension pneumocephalus
Subjects: R Medicine > RF Otorhinolaryngology
Divisions: Faculty of Medicine > Otorhinolaryngology Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 15 Oct 2023 06:49
Last Modified: 15 Oct 2023 06:49

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