Endoscopic management of skull base defects associated with persistent pneumocephalus following previous open repair: A preliminary report

Abstract

Objective: To describe the management of anterior skull base defects in patients who present with pneumocephalus after previous open neurosurgical intervention. Study Design: Case series with chart review. Setting: Tertiary referral center. Subjects and Methods: Patients repaired endoscopically for symptomatic pneumocephalus between April 1, 2005, and July 1, 2008. Volumetric calculation of the amount of intracranial air based on the preoperative CT scan was performed. Results: Six patients met inclusion criteria. The etiology of skull base defects was accidental trauma in two patients and surgical trauma in the remaining four. Average time from the open intervention until endoscopic repair was 28 days. Intrathecal fluorescein was utilized in five cases, but visualized at the site of the defect in only one patient. All patients were treated with a similar endoscopic technique. A simple free mucosal graft was used in four patients; a mucosal graft was placed over a layered reconstruction consisting of acellular dermal matrix in two patients, with one patient receiving septal cartilage. Closure of defects was achieved in all six patients with complete resolution of pneumocephalus in five patients after an average of 17 days; one patient had trace amounts of pneumocephalus (< 2 cc) at 10 days. Mean follow-up was seven months. Conclusion: Endoscopic techniques employed in this preliminary report demonstrate promising results in managing skull base defects associated with clinically significant pneumocephalus following failed prior open neurosurgical repair. The small population size in this study, however, precludes definitive conclusions regarding efficacy.