Intracranial complications before and after endoscopic skull base reconstruction

Background: Endoscopic skull base reconstruction (ESBR) has been widely accepted in the management of cerebrospinal fluid (CSF) leaks. However, it is not the CSF leak itself but the potential for life-threatening intracranial complications (ICCs) that is of primary clinical concern. The risk of developing complications, such as meningitis, in a skull base defect is unknown. Many ESBR are multilayered soft tissue repairs, and long-term prevention of ICCs is not well described. Methods: Retrospective chart review and telephone consultation was used to assess patients who had an ESBR from 2002 to 2008. The incidence of an ICCs (meningitis, cerebral abscess, and pneumocephalus) and associated risk factors were assessed before and after surgery. Results: One hundred six patients underwent ESBR (mean age (±SD), 47.7 ± 18.5 years; range, 2-78 years) with 95.3% long-term follow-up (mean, 19.9 ± 16.3 months). ICCs occurred in 21.7% of patients at presentation, in 2.8% of patients during the perioperative period (<2 weeks), and in one patient (0.9%) during the postoperative period. Risk factors for presenting with an ICC and meningitis were revision cases performed elsewhere (χ² = 9.10; p = 0.007) and leaking encephaloceles (χ² = 5.98; p = 0.014). Factors not associated with increased ICC were an active CSF leak at presentation (χ² = 3.03; p = 0.082) and previous radiotherapy. Conclusion: ESBR offers an excellent long-term option in preventing subsequent ICC with low perioperative complications. ESBR is robust with delayed (>2weeks) CSF leakage occurring in only 1.9% regardless of etiology. The presence of identifiable risk factors for ICC may guide the surgeon in determining the urgency ESBR.