Pneumocephalus as a infrequent complication of anterior skull base endoscopic surgery

Abstract

The endoscopic approach is an alternative in the management of oncological pathology of the anterior skull base, but it is not exempt from complications. The objective is to present the case of a patient who developed pneumoencephalus and brain abscess after skull base cancer surgery. A 72-year-old man with naso-ethmoidal adenocarcinoma with intracranial involvement. Endoscopic resection was performed using a trascribiform approach and closure of the multilayer anterior skull base defect together with neurosurgery. At 20 days he presented headache and compromised consciousness. Contrast-enhanced brain tomography reveals pneumocephalus and brain abscess. An endoscopic review was performed, evidencing a gap in the closure of the skull base. The intracerebral collection and pneumoencephalon were evacuated endoscopically, closing the multilayered defect. It evolves torpidly, requiring frontal cranialization and tracheostomy, evolving satisfactorily. Pneumoencephalus is the presence of air in the cranial cavity, being infrequent in its severe forms, with high morbidity and mortality, requiring early diagnosis. It can be associated with an abscess with a probable common genesis. Its management is surgical, multidisciplinary, by an otolaryngologist and neurosurgeon