Endoscopic Repair With Contralateral Septal Flap and Fascia Lata for Iatrogenic Skull Base Defect

Abstract

Iatrogenic skull base injury may occur during sinus surgery, and endoscopic repair is considered the gold standard for treatment. We report a 65-year-old male who experienced an iatrogenic ethmoid roof defect caused by endoscopic sinus surgery, eventually leading to four reoperations of endoscopic repairs. Autologous fascia lata and contralateral nasoseptal flap were mainly utilized for this revision case. Following 29 days of hospitalization, which included absolute bed rest with lumbar drainage for 22 days, there was a gradual improvement in the cerebrospinal fluid (CSF) profile and mental status. Additionally, the patient underwent ventriculoperitoneal shunt placement to address non-obstructive hydrocephalus resulting from meningitis, ultimately allowing him to return to his normal daily life. Critical factors in managing large skull base defects with high-flow CSF leakage include multi-layer reconstruction with fascia lata and a pedicled nasoseptal flap, sufficient control of intracranial pressure with CSF drainage and positioning, and infection control through appropriate antibiotics.