Severe intracranial complications during FESS; endoscopic reconstruction with cartilage from the cavum conchae

With the introduction of functional endoscopic sinus surgery (FESS) for paranasal sinus pathology, a technique became available with superior magnification and exposure of the operation area compared to conventional endonasal surgery. Given the close anatomic relation, there is a risk of major complications such as orbital and skull base complications. In this case report, we present a 66-year old man who is readmitted with massive pneumocephalus and reduced consciousness after bilateral ethmoidectomy and polypectomy with a direct postoperative orbital complication. The skull base defect is repaired endoscopically using a free cartilage graft from the cavum conchae. In the Netherlands there is no national registration of these complications, despite the morbidity of these complications. The exact incidence in the Netherlands is therefore unknown. We propose a nationwide registration system of major complications after FESS to gain insight in this serious problem.